Figure 1. Time course of treatment in the general ward. Antibiotics were administered during the first week after admission; however her inflammatory markers remained elevated and her fever persisted. Anasarca with fluid retention showed extreme progression, and a blood examination revealed thrombocytopenia and developed renal dysfunction. She was diagnosed as TAFRO syndrome. Diuretics had no effect on her fluid retention, steroid pulse therapy followed by steroid maintenance therapy and hemodialysis was performed in an attempt to improve her fluid retention. However, no therapeutic effect was obtained. Finally, she was admitted to the ICU. TAFRO: thrombocytopenia, anasarca, fever, reticulin myelofibrosis/renal insufficiency, and organomegaly; HD: hemodialysis; PSL: prednisolone; CTRX: ceftriaxone; MEPM: meropenem; BT: body temperature; Cr: creatinine; Plt: platelet; ICU: intensive care unit.
Figure 2. Time course of treatment in the ICU. Mechanical ventilation support was required after endotracheal intubation due to respiratory failure, and CRRT was performed due to renal failure. PE was performed using albumin replacement for 2 days and fibrinogen replacement for 4 days. The rapid initiation of PE was very effective. Her fever quickly declined, her inflammatory reaction decreased, and her anasarca with fluid retention showed a dramatic improvement. After the beneficial effects of PE, rituximab was initiated. PE: plasma exchange; CRRT; continuous renal replacement therapy; RBC: red blood cell; Plt: platelet; FFP: fresh frozen plasma; PSL: prednisolone; NAD: noradrenaline; VCM: vancomycin; PIPC/TAZ: tazobactam/piperacillin; MEPM: meropenem; CRP: C-reactive protein; ICU: intensive care unit.
Figure 3. Abdominal computed tomography scan during hospitalization. (a) On admission. (b) Fourteen days after admission. (c) Twenty-four days after admission. (d) Thirty-three days after admission. Anasarca with fluid retention showed extreme progression before ICU admission (until 24th day after admission). After the treatment of plasma exchange, her anasarca with fluid retention showed a dramatic improvement. ICU: intensive care unit; PE: plasma exchange.