On February 20, 2017, a 15-year-old boy with a 10-year history of recurrent cough and expectoration was presented. A definitive diagnosis of pulmonary CF was made through genetic testing (mutation on p.G970D) and sweat testing at the Beijing Children's Hospital in 2012. Additionally, a definitive diagnosis of hepatic cirrhosis was also made at the Beijing Children's Hospital 6 years previously. The first episode of hematemesis occurred in June 2017, which improved after an antibiotic's regimen and hemostasis treatment.
Six days earlier, the patient's parents reported he had begun coughing again, accompanied by sticky white and yellow sputum, chest pain and distress, nausea without dyspnea, hemoptysis, and so on, and presented a fever, which reached a maximum of 38.0 C. Chest and upper abdomen computed tomography scans revealed double-lung emphysema and mild bronchiectasis complicated by multiple liver conditions including hepatic cirrhosis, collateral circulation formation, and a slight amount of ascites. Examinations carried out on February 20, 2018, indicated the following abnormalities: blood count (white blood cell count = 10.3 x 109/L, hemoglobin = 131 g/L, platelet = 130 x 109/L), liver functionality (total bilirubin = 136.9 micromol/L, aspartate transaminase = 76.9 U/L, alanine transaminase = 63.5 U/L), levels of prothrombin time (18.1 seconds), and activated partial thromboplastin time (48.6 seconds). Other biochemical tests, including C-reactive protein, were normal, and the serum G test was positive (135.50 pg/mL). Pathogens including methicillin-resistant Staphylococcus aureus, Pesudomonas pyocyaneum, gram-positive cocci, fungi, and Mycoplasma pneumonia immunoglobulin M were all detected from the sputum culture, gram stain, serum G test, and respiratory tract profile (immunoglobulin M), while tuberculosis was absent from the sputum culture and tuberculin skin test. The patient was diagnosed with bronchiectasis, complicated by infection, CF lung, esophagogastric vein ligation (postoperative), hepatic cirrhosis decompensation, chronic disease-related malnutrition, hyperbilirubinemia, multiple organ failure (heart, liver, lung), and acquired coagulation dysfunction. These symptoms resolved after administering antibiotics and nutritional supplementation. However, after a transfusion of approximately 250 mL of fresh blood on March 6, 2018, the patient suffered a sudden episode of hematemesis, accompanied by dizziness, weakness, palpitations without fever, tachypnea, and loss of consciousness. On admission the patient was treated by hemostasis under endoscopic and other supportive agents. The patient's symptoms rapidly improved, and he was soon discharged.
Figures 1 and 2 show respectively double-lung emphysema, minor bronchiectasis complicated by infection, and diffuse liver diseases.