PMC9816402_01
Metagenomic next-generation sequencing (mNGS) of peripheral blood sample of the patient. (A) The nucleotide position and coverage of Leishmania donovani detected by mNGS. The coverage was 1.5885%. (B) mNGS of blood samples showed a total of 6,120 reads identified as microbial genome sequences, of which 5,946 reads belonged to Leishmania donovani, accounting for 97.16% of the total.
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Table 1 ). These tests revealed pancytopenia, increased ESR, CRP, and ferritin, and elevated liver enzymes. mNGS of blood samples showed a total of 6,120 reads identified as microbial genome sequences, of which 5,946 (97.16%) reads belonged to Leishmania donovani ( Figure 1 ).
Bone marrow smear. (A) Amastigote in the bone marrow. (B) A large number of amastigotes in the bone marrow. (C) Phagocytosis of platelets by macrophages in the bone marrow. (D) Phagocytosis of platelets and nucleated red blood cells by macrophages in the bone marrow. (E) Amastigotes invading macrophages in the bone marrow. (F) Bone marrow smear after treatment showing normal morphology of bone marrow cells, with no hemophagocytic cells or amastigotes.
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Bone marrow smear revealed an increase in the number of hemophagocytes, and amastigotes could been observed ( Figures 2A-E ). The results of bone marrow puncture on March 1, 2022, showed no abnormalities in the morphology of bone marrow cells, and no hemophagocytic cells nor amastigotes were observed ( Figure 2F ).
Timeline of the patient's illness, diagnosis, and treatment. T, temperature; SLE, systemic lupus erythematosus; LN, lupus nephritis; ENA, autoantibody spectrum; HLH, hemophagocytic lymphohistiocytosis; TPO, recombinant human thrombopoietin; G-CSF, granulocyte colony-stimulating factor; mNGS, metagenomic next-generation sequencing; CT, computed tomography.
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A timeline depicting the patient's condition, diagnosis, and treatment is presented in  Figure 3 .
Changes of patient's temperature, white blood cell (WBC), platelets (PLT), and serum enzyme levels. (A) Change of patient's temperature. (B) Changes in WBC and PLT. (C) Changes in serum enzyme levels.
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The changes in the patient's laboratory indicators are shown in  Figure 4 .