Hemorrhagic Fever with Renal Syndrome Complicated with Rhino Mucormycosis: A Case Report

Figures & data

Table 1 Laboratory Test Indicators at Admission into the ICU

Variable	Value	Reference/Normal Range	Elevated/Normal/Low
Blood cell count
Red cell count	4.77	4.5–5.74 ×10^12/L	Normal
Haemoglobin	168	110–150 g/L	Elevated
White cell count	23.05	3.5–9.5×10^9/L	Elevated
Neutrophil	87.4	40–75%	Elevated
Platelets	28	125–350×10^9/L	Low
Infection and inflammatory markers
Procalcitonin	3.26	<0.5 ng/mL	Elevated
HFRS anti-IgM antibody	Positivity	Negative	-
HFRS anti-IgG antibody	Positivity	Negative	-
Bronchoalveolar lavage fluid GM	1.29	<1.0	Elevated
Serum GM	4.99	<0.5	Elevated
1.3-beta-D-glucan	<10	<60 pg/mL	Normal
Liver function
Albumin	20.86	35–55 g/L	Low
ALT	3250.02	0–40U/L	Elevated
AST	8921.60	0–40U/L	Elevated
TBIL	35.16	6–20.5μmol/L	Elevated
DBIL	22.18	0–6μmol/L	Elevated
Kidney function
BUN	15.73	2.9–7.1mmol/L	Elevated
CRE	330.02	53–97μmol/L	Elevated
Cystatin	2.39	0.20–1.50mg/L	Elevated
Coagulation profile
APTT	99.8	28.0–43.5 seconds	Elevated
TT	83.5	14.0–21.0 seconds	Elevated
PT	25.3	11.0–14.0 seconds	Elevated
D-dimer	13.30	0–0.50 mg/L	Elevated
FIB	1.28	2.00–4.00 g/L	Low
Arterial blood gas (mechanical ventilation; PEEP, 12 cmH2O; FiO2, 60%)
PH	7.284	7.35–7.45	Low
PCO2	16.8	35–45mmHg	Low
PaO2	107	83–108mmHg	Normal
HCO3^−	7.7	21–27 mmol/L	Low
BE	−17.3	−3 to +3mmol/L	Low
Lactate	12.8	0.5–1.6 mmol/L	Elevated
Urinalysis
Protein	3+	Negative	Elevated
Cast (low fold)	20.24	0/LP	Elevated
Faeces test	Normal	-	Normal
Bronchoalveolar lavage fluid culture	Aspergillus fumigatus	-
Microbial cultures from the nasal necrotic lesions samples	Rhizopus oryzae complex

Abbreviations: GM, Galactomannan; ALT, alanine transaminase; AST, aspartate transaminase; TBIL, total bilirubin; DBIL, direct bilirubin; BUN, blood urea nitrogen; CRE, creatinine; APTT, Activated partial thromboplastin time; TT, thrombin time; PT, prothrombin time; FIB, fibrinogen; PEEP, positive end expiratory pressure; FiO₂, fraction of inspiration O₂; PH, pondus hydrogenii; PCO_2, partial pressure of carbon dioxide; PaO_2, arterial partial pressure of oxygen; HCO₃⁻, bicarbonate; BE, base excess.

Figure 1 The left nasal alar revealed purple and swollen.

Figure 2 (A) Sabouraud dextrose agar: Villous colonies after 48 hours. (B) Light microscope×200: large sporangia, rhizoids, hold capsule upright vertical.

Figure 3 Mass spectrum of Rhizopus oryzae complex, 99.9% confidence.

Figure 4 After 12 days of treatments, the left nasal scab fell off and a large tissue defect remained.