PMC8424244_01
(a) CTA of chest (February 16, 2020) with Type B aortic dissection (T: true lumen; F: false lumen). (b) Chest X-ray (February 28, 2020) with bilateral pulmonary opacities and pleural effusions.
CRIPU2021-5484239.001.jpg
PMC8424244_01_CRIPU2021-5484239.001.jpg
fig1
Type B aortic dissection was suggestive of pulmonary embolism and showed ground glass attenuation of the bilateral aerated lung fields and consolidation of the left lower lobe (Figure 1(a)). The patient was advanced to BiPAP without improvement and was transferred to the cardiopulmonary critical care unit for hypoxic respiratory failure, requiring intubation on February 24, 2020. Chest X-ray on February 28, 2020, showed bilateral pulmonary opacities and pleural effusions (Figure 1(b)).
SARS-CoV-2 nucleocapsid protein immunofluorescence in lung. Arrows indicate green positive signal. A = alveolar space. Blue = DAPI nuclear stain.
CRIPU2021-5484239.002.jpg
PMC8424244_01_CRIPU2021-5484239.002.jpg
fig2
Immunofluorescence for SARS-CoV-2 nucleocapsid protein was focally positive on one lung section (Figure 2).
(a) Lung H&E 4x (scale bar: 600 mum) with diffuse alveolar hemorrhage and alveolar fibrin. (b) SARS-CoV-2 ISH 4x (scale bar: 50 mum). (c) SARS CoV-2 ISH 40x (scale bar: 50 mum). (d) Heart H&E 20x E: Heart SARS-CoV-2 ISH 20x (scale bar: 200 mum). (f) Heart SARS CoV-2 ISH 40x (scale bar: 50 mum). Black arrows: positive antisense SA RS-CoV-2 RNA probe red signal.
CRIPU2021-5484239.003.jpg
PMC8424244_01_CRIPU2021-5484239.003.jpg
fig3
ISH showed SARS-CoV-2 in the lungs, myocardium, liver, kidneys, and brain (Figures 3 and 4).
SARS-CoV-2 ISH of the liver (a) and kidney (b) (40x: scale bar, 60 mum) and midbrain (c) (2x: scale bar, 600 mum) and inset 40x (scale bar, 50 mum). A: cerebral aqueduct. Black arrows: red signal (antisense strand RNA-replicating virus). White arrows: turquois signal (sense strand RNA-nonreplicating virus).
CRIPU2021-5484239.004.jpg
PMC8424244_01_CRIPU2021-5484239.004.jpg
fig4
ISH showed SARS-CoV-2 in the lungs, myocardium, liver, kidneys, and brain (Figures 3 and 4). Sections of the liver and kidney showed areas of turquoise signal indicating nonreplicating virus in addition to red replicating virus signal (Figure 4). Replicating virus signal was present in the ependymal lining cells and in the parenchyma of the midbrain (Figure 4(c)).