PMC7878548_01
Dynamic changes in patient treatment and biochemical indicators.
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F1
MB isoenzyme (CK-MB) 109.0 U/L (normal: 0-24 U/L); brain natriuretic peptide (BNP) 6,390.00 pg/ml (normal: 0-99 pg/ml); troponin I 9.64 ng/ml (normal <0.014 ng/ml); myohemoglobin 1,943.7 ng/ml (normal: 20-80 ng/ml). Moreover, liver function test results also showed elevation of aspartate aminotransferase (AST), 661 U/L (normal: 15-40 U/L), and alanine aminotransferase (ALT), 212 U/L (normal: 9-50 U/L) (Figure 1). The echocardiogram demonstrated a subnormal left ventricular ejection fraction (EF, 50%), and no abnormalities were found by coronary angiography (Supplementary Figure S1). CK, BNP, and troponin I decreased gradually and returned to normal (Figure 1). Considering the patient's clinical situation, we replaced the temporary pacemaker with a permanent pacemaker on the eighth day of implantation (Figure 2).
ECG siagnosis, which showed a complete left bundle branch block and monitoring ECG of treatment.
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F2
The electrocardiogram (ECG) showed complete left heart block (Figure 2). Then, a temporary pacemaker was implanted and steroid therapy was continued (Figure 2). CK, BNP, and troponin I decreased gradually and returned to normal (Figure 1). Considering the patient's clinical situation, we replaced the temporary pacemaker with a permanent pacemaker on the eighth day of implantation (Figure 2).
The histological examination of muscle tissue biopsy specimen. Black arrow showed focal lymphocyte infiltration.
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F3
Muscle biopsy indicated partial myofibril cavity degeneration, myolysis, and most of the striated interstitium showed focal lymphocyte infiltration, which was consistent with drug-induced myopathy, and it supported the original diagnosis (Figure 3).
Chest X-ray (A) and computed tomography (B) of the process of pneumonitis finding and treatment.
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F4
Chest X-ray imaging and computed tomography (CT) showed percolate increasing of lung (Figure 4). The patient was treated with antibiotics (ganciclovir and cefmetazole) for 7 days; however, his dyspnea did not improve and chest X-ray imaging and CT showed increasing of percolate (Figure 4). His symptoms were significantly improved after 3 days of methylprednisolone therapy (Figure 4).