Table 1 The manifestations, diagnostic testing, and interventions in the patient's medical file

Dates

Relevant past medical history and interventions

22/3–26/3

Five days ago, she underwent medical abortion and curettage, and later felt muscle pain, fatigue, fever, sore throat, and headache. The local results indicated hypo thrombocytosis and liver function damage and received anti-thermal treatment (unspecified medicine)

Dates

Summaries from Initial and Follow-up Visits

Diagnostic Testing

Intervention

2022/3/27

Aggravating muscle soreness for two days, followed by chills, fever, sore throat for one day

Lab’s test: Routine blood, specimen culture, Weil-Felix Reaction, Dengue fever antigen and Widal Reaction

Chest and Abdomen CT

Doppler Ultrasound in Gynecology

1 Empirical doxycycline 0.2 g

2. Symptomatic and supportive treatment

3 Monitor urine output

4 Gynecological Consultation

2022/3/28

Dry mouth and mild edema in lower extremities; blurred vision and pain in both eyes, and conjunctival hyperemia

CRP 200.30 mg/L and Myoglobin 675.90 ng/ml

Additional lab examinations include Epidemic hemorrhagic fever antibody and parathyroid hormone etc

Mydriatic fundus photography or OCT fundus scan

High-throughput sequencing testing

1 Moxifloxacin 0.4 g QD

2 Nephrology and Ophthalmology Consultation

3 A high-quality low-protein diet and compound α-keto acid in three meals

4 Sodium bicarbonate 1.0 g TID

5 Atomolan 1 g*QD;

2022/3/28

Chest tightness, shortness of breath (SOB), decreased urine output, and severe pitting edema in lower extremities at night

Lactic acid: 5.14 mmol/L and Pro-BNP: 3222 pg/ml

CVP = 1cmH2O

Creatinine 140umol/L and Urea 10.77 mmol/L

1. Indwelling CVC and urinary catheter

2. Diuresis but without urine output, and then fluid resuscitation

2022/3/29

Increased swelling in lower extremities, dry mouth, blurred vision in both eyes, and orbital pain

Labs: CRP 193.60 mg/L; IL-6 4847 pg/ml, PCT 13.11 ng/ml; WBC 13.73*10^9/L, PLT 42*10^9/L; D-D 5.57 mg /L, FDP 2.40 mg/L and hypothyroidism

1 Moxifloxacin 0.4 g QD

2 Symptomatic treatment such as diuretics

2022/3/30

Reduced muscle strength from level 3 to 1

Cerebrospinal fluid workup

Further endocrine testing: cortisol, ACTH etc

1 Moxifloxacin 0.4 g QD

2 Neurology and Endocrinology consultation

3 Lumbar punctures

2022/3/31

Unrelieved muscle soreness, Passive position (bedridden)

The total amount of protein testing etc

EMG and myositis antibody test, and muscle biopsy if necessary

1 Supplemental albumin therapy and discontinuation of diuretics

2 Glucocorticosteroid therapy is contraindicated

2022/4/1

Improved muscle strength

Increased CK and CK-MB

1 Piperacillin-tazobactam sodium 4.5 g*Q8H

2 Nutritional support

3 Monitor fluid balance

2022/4/3

Fatigue and muscle soreness improved slightly。

24-h urine volume: 4250 ml/C, fluid balance: -2098 ml

CVP = 3cmH2O

1 Penicillin 4.8 million U*BID

2 Pharmacist, Rheumatology, and Immunology Consultation

3 Fluid resuscitation and albumin supplementation

2022/4/3

Transient chest tightness and SOB at night

HGB 76 g/L and Pro-BNP: 5182 pg/ml, etc

1 Diuretics

2022/4/4

Edema and muscle tenderness improved but still SOB

Normal CK and CK-MB

Chest CT: Slight bilateral pleural effusion, enlarged heart, and minor pericardial effusion

1 Penicillin 4.8 million U*BID

2 Continue albumin therapy, and chest tube drainage if necessary

3 Prevent pressure injuries

2022/4/6

Right eye swelling and pain; Bedsores on the sacrococcygeal region

Ophthalmology Consultation: right eye conjunctival hyperemia

1 Penicillin 4.8 million U*ID

2 Tobramycin Eye Drops

3 Skin care

2022/4/9

Active position and soreness in limbs without tenderness

The upper and lower Muscle Strength grading were 5 and 4, respectively;

Penicillin 4.8 million U*BID

2022/4/11

Walking slowly, mild muscle pain

Midstream urine culture: ESBLs without manifestations

Echocardiography: minor pericardial effusion

1 Penicillin 4.8 million U*BID

2 Removed the urinary catheter and CVC on 10/4 and 12/4 respectively

2022/4/13

Muscle soreness, muscle strength level 5

WBC 7.21*10^9/L, HGB 88 g/L, PLT 467*10^9/L; PCT 0.05 ng/ml; Pro-BNP 915.70 pg/ml; creatinine 48umol/L, albumin 35.50 g/L;

Discharged on 14th April and outpatient follow-up

2022/5/18

Recovery