PMC5498209_01
Computed tomography (CT) scans. CT scans taken during the initial visit to a local hospital showed mild pneumonia in the right upper lobe (a) and mild-to-moderate splenomegaly (b). An abdominal CT scan 31 days after starting prednisolone showed improvement of the splenomegaly (c).
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Blood tests revealed severe leukopenia (700/muL), and a computed tomography (CT) scan revealed pneumonia in the right lung and mild-to-moderate splenomegaly (Fig. 1a and b). Abdominal CT revealed improvement in her splenomegaly (Fig. 1c), and she was discharged four days later.
A bone marrow biopsy (a) and smear (b). A bone marrow biopsy revealed a slightly hypercellular marrow (a). Bone marrow smears revealed a decrease in the numbers of segmented neutrophils without morphological dysplasia in the hematological cell lineages (b). Original magnifications: (a)x40, (b)x1,000.
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A bone marrow biopsy revealed a slightly hypercellular marrow with mild reticulin fibrosis (Fig. 2a). Bone marrow smears revealed a decrease in mature segmented neutrophils (0.4%) with a relative increase in myelocytes without an increase in blastic cells (Fig. 2b, Supplementary Table 2).
Clinical course. The treatments and white blood cell counts (per muL) are shown. The left and right panels show the clinical course of the first 3 weeks and 11 months after the initiation of prednisolone, respectively. TAZ/PIPC: tazobactam/piperacillin, G-CSF: granulocyte-colony-stimulating factor, PSL: prednisolone, WBC: white blood cell count, ANC: absolute neutrophil count
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However, her neutrophil count, which was 130/muL on admission, did not respond to G-CSF therapy through day 8, so we discontinued G-CSF therapy and started oral prednisolone at a dose of 0.5 mg/kg/day (Fig. 3). Her neutrophil count began to increase immediately (Fig. 3). The prednisolone dosage was gradually tapered and was discontinued 10 months after its initiation (Fig. 3).