case_images: PMC8013633_01
case_images: (A) Axial postmortem computer tomography scan of the consolidated lungs with peripheral ground glass opacities (solid arrows) and 'crazy paving' indicating oedema of the interstium (open arrow). (B) Axial postmortem computer tomography scan of the consolidated lungs with air entrapment (solid arrows) and "crazy paving," indicating oedema of the interstitium (open arrow). Microscopic pulmonary findings of diffuse alveolar damage showing a spectrum of acute exudative lesions (C-D) to a more consolidated phase with proliferation and organization (E), including a thrombus in the vasculature (F, arrow) (Hematoxylin and eosin staining, 200x). Microscopic immune-histochemical findings showing the deposition of C4d complement fraction in the alveolar structures (G) and microvasculature (H) (IHC for C4d stain; 200x).
case_images: 10.1177_2632010X211006096-fig1.jpg
case_images: PMC8013633_01_10.1177_2632010X211006096-fig1.jpg
case_images: fig1-2632010X211006096
case_images: Postmortem computer tomography revealed uniformly consolidated lungs bilaterally with air entrapment (Figure 1A). The histopathology of the lung tissue revealed universally severe diffuse alveolar damage ranging from characteristic acute changes to more chronic changes (Figure 1C-F). The endothelium in the vasculature was severely hypoplastic with necrotizing, thrombotic microangiopathy. The complement fraction C4d (Figure 1G and H) was expressed in the endothelium.
case_images: Phylogenetic analysis of patient sequences. Phylogenetic tree rooted with the Wuhan-Hu-1 sequence (NC_045512) and GISAID sequences, shown for example EPI ISL 420347 (GISAID identifier) A2 (Nextstrain clade) and the 4 patient sequences (spinal, tracheal, right lung, and left lung).
case_images: 10.1177_2632010X211006096-fig2.jpg
case_images: PMC8013633_01_10.1177_2632010X211006096-fig2.jpg
case_images: fig2-2632010X211006096
case_images: The phylogenetic analysis (Figure 2) showed that all 4 virus samples belonged to the A2a clade (corresponding to clade 20B by the classification system implemented in Nextclade: https://clades.nextstrain.org/results).