PMC5758846_01
Dynamic contrast-enhanced CT scan.
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An abdominal and chest dynamic contrast-enhanced CT scan revealed periportal collar sign, splenomegaly, and a small amount of ascites and pleural effusion (Figure 1).
The patient's clinical course. MINO: minocycline, AZM: azithromycin, CTRX: ceftriaxone, VCM: vancomycin, CZOP: cefozopran; mPSL: methylprednisolone sodium succinate.
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The patient was treated six times with hemodialysis filtration (HDF) and four times with peritoneal dialysis (Figure 2). Although the origin of the fever was not determined, infectious disease was suspected, and the patient was treated with antibiotics as shown in Figure 2.
Findings of liver needle biopsy. (a) The arrow indicates a nuclear inclusion body. (b) Low magnification (x40) of a liver fragment with HE and AZAN staining.
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Histopathological findings showed piecemeal necrosis and nuclear inclusion bodies (Figure 3(a)). The pathological diagnosis of a fragment of liver tissue indicated periportal hepatocellular loss and regenerative bile duct (Figure 3(b)).
Alignment of patient serum RNA against human herpesvirus 2 reference genome. Reads were aligned using Bowtie2 and displayed using Tablet viewer.
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After remapping, 1,216,468 out of a total of 139,632,418 reads (0.87%) mapped to the NC_001798.2 human herpesvirus 2 reference genome, overlapping 80% of the 154,657 nt reference sequence with an average coverage depth of 768 and a maximum coverage depth of 6,991 (Figure 4).
Relative HSV-DNA levels on days 1, 2, and 28. HSV-DNA levels decreased to lower than 10-6 from day 1 to day 28.
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RT-PCR analysis confirmed the presence of HSV-DNA in the patient's blood samples at the time of admission and revealed that HSV-DNA levels had decreased by a factor of 10-6 between days 1 and 28 (Figure 5), shortly after which the patient was discharged.