28207542 Visualization

A 22 Age - year Age - old Age Tibetan Personal_background man Sex without History significant History past History medical History history History was diagnosed with pulmonary Disease_disorder tuberculosis Disease_disorder ( PTB Disease_disorder ) in a routine Detailed_description medical examination Diagnostic_procedure and received anti Medication - TB Medication therapy Medication that included isoniazid Medication ( INH Medication , 300 Dosage   mg/d Dosage ), RMP Medication ( 450 Dosage   mg/d Dosage ), ethambutol Medication ( EMB Medication , 750 Dosage   mg/d Dosage ), and pyrazinamide Medication ( PZA Medication , 1500 Dosage   mg/d Dosage ).
After 1 Duration week Duration of continuous therapy Coreference , he was admitted Clinical_event to the Tibet Nonbiological_location People's Nonbiological_location Hospital Nonbiological_location with nasal Biological_structure hemorrhage Sign_symptom and the platelet Diagnostic_procedure ( PLT Diagnostic_procedure ) count was 0.4 Lab_value   × Lab_value   109/L Lab_value (normal range, 100–300 × 109/L).
Epistaxis Sign_symptom was cured after symptomatic Therapeutic_procedure treatment Therapeutic_procedure .
Two Date days Date later Date , he developed hematochezia Sign_symptom , hematuria Sign_symptom , and purpura Sign_symptom , and required transfusion Therapeutic_procedure of fresh Medication - frozen Medication plasma Medication and platelets Medication in another Nonbiological_location local Nonbiological_location hospital Nonbiological_location .
Four Date days Date later Date ( November Date 18, Date 2015 Date ), he was transferred Clinical_event to the West Nonbiological_location China Nonbiological_location Hospital Nonbiological_location due to the ineffective Qualitative_concept treatment Therapeutic_procedure .
On physical Diagnostic_procedure examination Diagnostic_procedure , he presented with pallor Sign_symptom , mild Severity jaundice Sign_symptom on the sclera Biological_structure , purpura Sign_symptom , tachycardia Sign_symptom ( heart Diagnostic_procedure rate Diagnostic_procedure 132/min Lab_value ) and weak Sign_symptom breath Sign_symptom sounds Sign_symptom at the base Biological_structure of Biological_structure the Biological_structure left Biological_structure lung Biological_structure .
Laboratory Diagnostic_procedure results Diagnostic_procedure on admission Clinical_event indicated DIC Disease_disorder : prothrombin Diagnostic_procedure time Diagnostic_procedure ( 17.8 Lab_value   seconds Lab_value ; normal range, 9.6–12.8 seconds), international Diagnostic_procedure normalized Diagnostic_procedure ratio Diagnostic_procedure ( 1.53 Lab_value ; normal range, 0.88–1.15), fibrinogen Diagnostic_procedure ( 1.13 Lab_value   g/L Lab_value ; normal range, 2.0–4.0 g/L), D Diagnostic_procedure - dimers Diagnostic_procedure ( 23.45 Lab_value   mg/L Lab_value ; normal range, <0.55 mg/L), fibrin Diagnostic_procedure degradation Diagnostic_procedure product Diagnostic_procedure ( 60.4 Lab_value   mg/L Lab_value ; normal range,<5 mg/L), and PLT Diagnostic_procedure ( 2 Lab_value   × Lab_value   109/L Lab_value ; normal range, 100–300 × 109/L).
Other abnormal data were as follows: white Diagnostic_procedure blood Diagnostic_procedure cell Diagnostic_procedure ( WBC Diagnostic_procedure , 48.38 Lab_value   × Lab_value   109/L Lab_value ; normal range, 3.5–9.5), hemoglobin Diagnostic_procedure ( 65 Lab_value   g/L Lab_value ; normal range, 130–175 g/L), total Diagnostic_procedure bilirubin Diagnostic_procedure ( 30.8 Lab_value umol/L Lab_value ; normal range, 5.0–28.0 umol/L), direct Diagnostic_procedure bilirubin Diagnostic_procedure ( 16.6 Lab_value umol/L Lab_value ; normal range, < 8.8 umol/L), aspartate Diagnostic_procedure aminotransferase Diagnostic_procedure ( 75 Lab_value U/L Lab_value ; normal range, <40 U/L), alanine Diagnostic_procedure aminotransferase Diagnostic_procedure ( 293 Lab_value U/L Lab_value ; normal range, <50 U/L), lactate Diagnostic_procedure dehydrogenase Diagnostic_procedure ( 380 Lab_value U/L Lab_value ; normal range, 110–220 U/L), serum Diagnostic_procedure urea Diagnostic_procedure nitrogen Diagnostic_procedure ( 13.01 Lab_value mmol/L Lab_value ; normal range, 3.2–7.79 mmol/L), C Diagnostic_procedure - reactive Diagnostic_procedure protein Diagnostic_procedure ( 16.70 Lab_value   mg/L Lab_value ; normal range, <5 mg/L), complement Diagnostic_procedure 3 Diagnostic_procedure ( 0.41 Lab_value   g/L Lab_value ; normal range, 0.785–1.520 g/L), and complement Diagnostic_procedure 4 Diagnostic_procedure ( 0.0797 Lab_value   g/L Lab_value ; normal range, 0.145–0.360 g/L).
Routine urine Diagnostic_procedure test Diagnostic_procedure showed blood Diagnostic_procedure cell Diagnostic_procedure >330 Lab_value   Cell/uL Lab_value , leukocyte Diagnostic_procedure 250 Lab_value Cell/uL Lab_value , protein Diagnostic_procedure 2 Lab_value   g/L Lab_value , and urobilinogen Diagnostic_procedure 70 Lab_value umol/L.
Routine stool Diagnostic_procedure test Diagnostic_procedure showed red Diagnostic_procedure blood Diagnostic_procedure cell Diagnostic_procedure 4+/HP Lab_value , white Diagnostic_procedure blood Diagnostic_procedure cell Diagnostic_procedure 1+/HP Lab_value , occult Diagnostic_procedure blood Diagnostic_procedure test Diagnostic_procedure ( + Lab_value ).
T Diagnostic_procedure - SPOT Diagnostic_procedure result was positive Lab_value .
Real Detailed_description - time Detailed_description polymerase Detailed_description chain Detailed_description reaction Detailed_description analysis Diagnostic_procedure for Diagnostic_procedure mycobacterium Diagnostic_procedure TB Diagnostic_procedure on sputum Detailed_description was positive Lab_value .
Acid Diagnostic_procedure fast Diagnostic_procedure stain Diagnostic_procedure test Diagnostic_procedure of a sputum Detailed_description smear Detailed_description was negative Lab_value .
Chest Biological_structure computed Diagnostic_procedure tomography Diagnostic_procedure ( CT Diagnostic_procedure ) on admission Clinical_event ( November Date 18, Date 2015 Date ) (Fig.1) showed infiltrates Sign_symptom on the upper Biological_structure lobe Biological_structure of Biological_structure the Biological_structure left Biological_structure lung Biological_structure , left Detailed_description pleural Disease_disorder effusion Disease_disorder , and pericardial Disease_disorder effusion Disease_disorder , accompanied by enlargement Sign_symptom of mediastinal Biological_structure lymph Biological_structure nodes Biological_structure .
Abdominal Biological_structure ultrasound Diagnostic_procedure showed a small Qualitative_concept amount Qualitative_concept of fluid Sign_symptom adjacent to the liver Biological_structure and spleen Biological_structure .
Serologic Diagnostic_procedure markers Diagnostic_procedure were negative Lab_value for acute Detailed_description or chronic Detailed_description viral Disease_disorder hepatitis Disease_disorder , HIV Disease_disorder , direct Diagnostic_procedure Coomb Diagnostic_procedure test Diagnostic_procedure , and autoimmune Disease_disorder hepatitis Disease_disorder .
Peripheral Detailed_description blood Detailed_description film Diagnostic_procedure and Diagnostic_procedure culture Diagnostic_procedure were negative Lab_value .
Bone Detailed_description marrow Detailed_description smear Diagnostic_procedure and Diagnostic_procedure medulloculture Diagnostic_procedure were also negative Lab_value .
The antituberculosis Medication drugs Medication were discontinued immediately after admission Clinical_event .
Besides fasting Therapeutic_procedure , he was initiated with infusion Administration of fresh Detailed_description - frozen Detailed_description plasma Medication , platelet Medication , packed Medication red Medication blood Medication cells Medication , intravenous Administration immune Medication globulin Medication , recombinant Detailed_description human Medication thrombopoietin Medication , omeprazole Medication , and polyene Medication phosphatidylcholine Medication as well as nutrition Therapeutic_procedure supportive Therapeutic_procedure treatment Therapeutic_procedure .
Five Date days Date after Date fasting Therapeutic_procedure ( November Date 23, Date 2015 Date ), the patient started a therapy consisting of EMB Medication , moxifloxacin Medication , and amikacin Medication , while he had no further active hemorrhage Sign_symptom .
Eight Date days Date after Date admission Clinical_event ( November Date 26, Date 2015 Date ), the platelet Diagnostic_procedure counts had risen Lab_value gradually.
INH Medication ( 200 Dosage   mg/d Dosage , intravenously Administration guttae Administration ) was administered on 24 Date days Date after Date admission Clinical_event ( December Date 11, Date 2015 Date ), while his liver Diagnostic_procedure function Diagnostic_procedure tests Diagnostic_procedure and platelet Diagnostic_procedure counts returned to normal Lab_value .
The main laboratory Diagnostic_procedure features Diagnostic_procedure are summarized in Table 1.
One Date month Date later Date ( December Date 17, Date 2015 Date ), reviewed chest Biological_structure CT Diagnostic_procedure (Fig.1) indicated the infiltration Sign_symptom , hydrothorax Sign_symptom , and pericardial Disease_disorder effusion Disease_disorder were absorbed well.
Almost about Date 4 Date weeks Date after Date admission Clinical_event , the patient recovered Outcome and left Clinical_event hospital Clinical_event with INH Medication ( 300 Dosage   mg/d Dosage ), EMB Medication ( 750 Dosage   mg/d Dosage ), levofloxacin Medication ( 500 Dosage   mg/d Dosage ), and streptomycin Medication ( 750,000 Dosage U/d Dosage , intramuscular Administration injection Administration ).
There was no recurrence of DIC Disease_disorder or hemorrhage Sign_symptom during 8 Duration months Duration of follow Clinical_event - up Clinical_event .
Unfortunately, the patient refused a follow-up chest Biological_structure CT Diagnostic_procedure after his discharge Clinical_event .
Table ​2 shows the timeline of this case.