PMC6069030_01
Select axial images of diagnostic abdominal computed tomography. An inflamed
colon with circumferential bowel wall thickening (arrowheads) was shown by
on initial study (A and B). After 3 days, a second scan (C and D)
demonstrated distension of the small intestine accompanied by air-fluid
levels (narrow arrow) and the accumulation of ascites (wide arrows) as well
as an exaggeration of bowel thickening (arrowhead).
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Diagnostic noncontrast abdominal computed tomography (CT) revealed an inflamed colon (Figure 1A and B). Despite these managements, the clinical status of the patient steadily worsened, and a second abdominal CT scan performed 3 days later revealed the exaggeration of bowel thickening, distension of the small intestine, and accumulation of ascites (Figure 1C and D) with a serum Cr level of 2.03 mg/dL and LDH level of 2662 IU/L.
Changes in several clinical parameters during hospitalization. On hospital
day 7, the patient no longer manifested thrombocytopenia and showed a
recovered platelet count above 15 x 104/muL; however,
normalization of the elevated serum LDH levels lagged behind by
approximately 3 weeks. Note that PEX combined with intermittent HD (vertical
bars on top) was performed on hospital days 2, 3, 4, and 7. HD indicates
hemodialysis; LDH, lactate dehydrogenase; PEX, plasma exchange.
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Despite the termination of the systemic treatments with rhTM and NM, his abnormal clotting and fibrinolytic profiles steadily improved, except for a slightly elevated prothrombin time (PT)-international normalized ratio (INR), which was presumptively ascribed to the reduced factor VII activity of 68.4% (reference range: 80.0%-115.0%) found on hospital day 24, and the serum levels of amylase and lipase also decreased gradually but slowly (Figure 2).