Multiple organ involvement in severe fever with thrombocytopenia syndrome: an immunohistochemical finding in a fatal case

Shibo Li, Yang Li, Qiujing Wang, Xuewen Yu, Miaomiao Liu, Haibo Xie, Liyong Qian, Ling Ye, Zhejuan Yang, Jianjing Zhang, Huimin Zhu, Wenhong Zhang

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease caused by SFTS bunyavirus (SFTSV), a tick borne bunyavirus. However, Immunohistochemistry of SFTS patients are not well studied. We obtained multiple of tissues from a fatal case with SFTS, including blood, lungs, kidneys, heart, and spleen. The blood samples were used to isolate the causative agent for detection of viral RNA and further expression of recombinant viral protein as primary antibody. Immunohistochemistry of the heart, lungs, spleen and kidneys was used to characterize the viral antigen in tissue sections. A 79-year-old man, together with his wife, was admitted because of fever. Both patients were diagnosed with SFTS by the positive SFTSV RNA in the blood. The gentleman died of multiple organ failure 8 days after hospitalization. However, his wife recovered and was discharged. Immunohistochemistry indicated that SFTSV antigens were present in all studied organs including the heart, kidney, lung and spleen, of which the spleen presented with the highest amount of SFTSV antigens. The kidney was next while the heart and lungs showed lower amount of SFTSV antigens. SFTSV can direct infect multiple organs, resulting in multiple organ failure and ultimately in an unfavorable outcome.