PMC9748288_01
Chest imaging. (A) Normal computed tomography (CT) image taken on February 18, 2022. (B) Normal CT image taken on May 18, 2022. (C) The CT image taken on June 10, 2022 shows scattered large high-density shadows in both lungs.
fmed-09-1036422-g001.jpg
PMC9748288_01_fmed-09-1036422-g001.jpg
F1
Computed tomography (CT) of the chest showed normal images (Figure 1A). CT images of the chest were normal (Figure 1B). CT images of the chest showed scattered large high-density shadows in both lungs, which suggested lung infection (Figure 1C).
Bone marrow aspiration, biopsy, and immunohistochemistry. Bone marrow aspiration was performed using Wright's staining technique. Bone marrow biopsy and immunohistochemistry were performed using staining techniques involving hematoxylin, Giemsa, acid fuchsin, reticular fiber, and Prussian blue stains. (A) Bone marrow aspiration in ilium performed on May 20, 2022. The results reveal low proliferation of nucleated cells without abnormality in morphology. (B) Bone marrow aspiration in sternum performed on May 24, 2022. The results reveal low proliferation of nucleated cells without abnormality in morphology. (C) Bone marrow biopsy and immunohistochemistry performed on May 20, 2022. Hematopoietic elements are substantially reduced (30%), and bone marrow space is replaced with adipose tissue (70%). Granulocyte and erythrocyte development are normal.
fmed-09-1036422-g002.jpg
PMC9748288_01_fmed-09-1036422-g002.jpg
F2
To clarify the cause of this condition, the hematology department was called upon for multidisciplinary combination therapy, and repeated bone marrow aspiration and biopsy were suggested (Figures 2A-C).
(A) White blood cell count. The normal reference ranges of the above data are listed in Table 1. (B) Red blood cell and hemoglobin counts. The normal reference ranges of the above data are listed in Table 1. (C) Platelet count. The normal reference ranges of the above data are listed in Table 1.
fmed-09-1036422-g003.jpg
PMC9748288_01_fmed-09-1036422-g003.jpg
F3
Combining with the results of blood routine tests before administering T. wilfordii, we believe that T. wilfordii caused bone marrow suppression (Figures 3A-C).