PMC9259318_01
Skin findings. Observations of crusted skin lesions (arrows) (A) and aggregated papules (arrow) (B).
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He additionally presented with crusted skin lesions on the medial surface of the left thigh (Fig. 1A), a freely movable adenopathy of approximately 2 cm in size without tenderness, and aggregated papules in the right inguinal region (Fig. 1B).
The clinical courses during hospitalization.
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Clinical course (Fig. 2): Given the physical and laboratory findings, on day 1 of hospitalization, we suspected sepsis and febrile neutropenia (FN) associated with hemophagocytosis.
Bone marrow biopsy. Bone marrow biopsy. Hemophagocytic image (arrow, x1,000). Mature myeloid series cell counts were decreased, and monocytoid cells and lymphoid cell counts were increased. immunohistological examination; CD3- and CD4-positive T cells, MUM-1-positive lymphoid cells, and CD68- and CD163-positive histiomonocytes cell counts were increased (x400). Image of anti-SFTSV antibody staining was positive (arrow, x1,000). HE: Hematoxylin and Eosin staining, MUM-1: multiple myeloma oncogene 1
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No EBV-encoded small RNAs (EBERs)-positive cells were detected (Fig. 3). The researchers found infected cells that were stained positively by an anti-SFTSV-nucleoprotein (N) antibody (Fig. 3).
ECG data obtained on day 3 of hospitalization. The ECG shows a slight ST elevation in the V1-2 leads (A), and it recovered to the normal level on day 14 of hospitalization (B).
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Transthoracic echocardiography showed severe left ventricular dysfunction [left ventricular ejection fraction (LVEF) of 15%], while an electrocardiogram (ECG) showed a slight ST elevation in the V1-2 leads (Fig. 4A). ECG showed improvement of ST elevation in the V1-2 leads (Fig. 4B).
Endomyocardial biopsy of the right ventricle. It revealed a non-specific pathology with mild/indefinite inflammatory infiltration (x100). Mild myocardial hypertrophy and nuclear swelling relative to the myocardial size are present (x200), with areas of marked regularization and mildly crude myofibrils (x100). Intrinsic deflection or explicit active inflammatory cell infiltration are not detectable. Immunostaining reveals increases in CD3-positive (T-cells), CD68-positive cells (macrophages) (x200), and tenascin-C expression (x100).
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However, immunohistochemistry revealed increases in the number of CD3-positive T cells (10/mm2) and CD68-positive macrophages (18/mm2) with tenascin-C expression in the stroma, suggesting an ancillary diagnosis of myocardial inflammation (Fig. 5).