case_images: PMC9379344_01
case_images: A schematic view of the patient's clinical history. NP, nasopharyngeal; SP, sputum through intubation tube; TnI, Troponin I; CK, creatine phosphokinase-MB isozyme.
case_images: fmed-09-959196-g001.jpg
case_images: PMC9379344_01_fmed-09-959196-g001.jpg
case_images: F1
case_images: He was admitted to the intensive care unit for COVID-19 and was administered oxygen, methylprednisolone, remdesivir, and tocilizumab for 4 days, 5 days, 3 days, and 1 day, respectively, which improved his dyspnea and chest CT findings (Figure 1). Coronary angiogram demonstrated three-vessel disease of the left main trunk, which required coronary artery bypass grafting (CABG) (Figure 1). The patient was discharged on the 12th day following the surgery without any complications (Figure 1). An area devoid of viral particles was also observed (Supplementary Figure 1).
case_images: The amplification plot of the laboratory real-time RT-PCR using a nucleocapsid phosphoprotein gene-specific primer set.
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case_images: PMC9379344_01_fmed-09-959196-g002.jpg
case_images: F2
case_images: The amplification plot is shown in Figure 2.
case_images: Images of SARS-CoV-2 in the patient's saphenous vein. Immunohistochemistry of the saphenous vein of (A) SARS-CoV-2 nucleocapsid, NC (green), and (B) spike, S (green). The asterisk in A indicates the position of the enlarged image shown in the inset. Autofluorescence, AF (red), and nuclear staining with DAPI, N (blue), are also shown. (C) Image of transmission electron microscopy of saphenous vein.
case_images: fmed-09-959196-g003.jpg
case_images: PMC9379344_01_fmed-09-959196-g003.jpg
case_images: F3
case_images: IgG (H + L) (Thermo Fisher Scientific, Waltham, MA, United States A21202), at room temperature for 30 min. After nuclear staining with DAPI (Thermo Fisher Scientific, Waltham, MA, United States) was performed, fluorescence signals were observed using fluorescence microscopy (Eclipse Ti2; NIKON, Tokyo, Japan). Immunohistochemistry revealed small clusters of antigen-positive speckles distinguished by autofluorescence (Figures 3A,B). Viral particles were observed in the saphenous vein (Figure 3C).
case_images: A cell-based type-I IFN assay. HepG2 cells were stimulated with the patient's serum and healthy control serum at 10% concentration for 18 h (N = 3). The cDNA was amplified separately. Error bars indicate standard deviations. Statistical significance (p < 0.05) is indicated by asterisks.
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case_images: PMC9379344_01_fmed-09-959196-g004.jpg
case_images: F4
case_images: As shown in Figure 4, type-I IFN stimulated genes, interferon-stimulated gene 15 (ISG 15) and myxovirus resistance A (MxA) expression levels were significantly higher in the HepG2 cells stimulated by the patient's serum.