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. 2021 Feb 12;21:88. doi: 10.1186/s12872-021-01900-2

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© The Author(s) 2021

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

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Fig. 1 — Histopathological findings of the skeletal muscle, cardiac tissue, and chest CT findings. Hematoxylin and eosin staining of the skeletal muscle showed scatter atrophic fibers (white arrow) and necrotizing myofibers (white arrowhead) (a × 200; b × 200). Enlarged heart was observed on the chest CT (c). Hematoxylin and eosin staining (d × 400) and Masson staining (e × 200) of the left ventricle revealed myofiber disarrangement, atrophy, and interstitial fibrosis with the absence of inflammatory infiltration. Immunohistochemistry analysis displayed p62/SQSTM1 was positive in some cardiomyocytes (f × 200). LC3 merely positively stained few cardiomyocytes (g × 200) and cleaved-caspase 3 mainly expressed on atrophic cardiac myofibers (h × 400) [inset negative control (NC) in f–h]. ECG demonstrated sinus rhythm, left anterior fascicular block and multifocal ventricular premature beat (i). Echo showed dilated left atrium and left ventricle (j in 2016 and k in 2019)