PMC8034239_01
Liver function changes and treatment flow chart.
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Approximately 1 week later, his ALT and AST levels decreased rapidly, and TBIL continued to deteriorate (Figure 1). Then, plasma exchange (PE) and a double plasma molecular absorption system (DPMAS) for blood purification were added, and cholestasis improved within a short time (Figure 1).
Changes in lung computed tomography scan. (a) At the beginning of the disease, the two lower lungs showed mild inflammation and exudation. (b) One month later, lung exudation aggravated; the clinical symptoms were chest tightness and shortness of breath. (c) Two weeks after treatment with methylprednisolone (1 mg/kg/day), the lesions were markedly absorbed, and the symptoms disappeared. (d) In the last week, pulmonary inflammation exacerbated, and mediastinal pneumothorax (arrow) appeared.
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Chest computed tomography (CT) scanning revealed interstitial inflammatory lesions in both lower lungs (Figure 2). Consequently, chest tightness and shortness of breath resolved, and pulmonary inflammation improved (Figure 2).
Pathological changes in a liver puncture. (a) Histological features of the liver were mainly lobular inflammation (arrow), with ductopenia, cholestasis of the capillary bile duct, and no obvious liver fibrosis (100, hematoxylin-eosin staining). (b) Panlobular hepatitis with lymphoplasmacytic infiltration (white arrow), hemorrhage of sinus endothelium (arrow), and cholestasis of capillary bile duct (red arrow) (200, hematoxylin-eosin staining).
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Liver biopsy revealed nonspecific immune injury (Figure 3).
Contrast-enhanced abdominal computed tomography showing heterogeneous enhancement of liver density.
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Contrast-enhanced abdominal CT showed heterogeneous enhancement of liver density (Figure 4).