The COVID-19 pandemic is a worldwide problem. The clinical spectrum of SARS-CoV-2 infection varies from asymptomatic or paucity-symptomatic forms to conditions such as pneumonia, acute respiratory distress syndrome and multiple organ failure. Objective: describe a clinical case of SARS-CoV-2 infection in the patient with sarcoidosis and cardiovascular pathology developing acute respiratory syndrome and lung edema. Material and Methods. There were analyzed accompanying medical documentation (outpatient chart, medical history), clinical and morphological histology data (description of macro- and micro-preparations) using hematoxylin and eosin staining. Results. Lung histological examination revealed signs of diffuse alveolar damage such as hyaline membranes lining and following the contours of the alveolar walls. Areas of necrosis and desquamation of the alveolar epithelium in the form of scattered cells or layers, areas of hemorrhages and hemosiderophages are detected in the alveolar walls. In the lumen of the alveoli, a sloughed epithelium with a hemorrhagic component, few multinucleated cells, macrophages, protein masses, and accumulated edematous fluid were determined. Pulmonary vessels are moderately full-blooded, surrounded by perivascular infiltrates. Signs of lung sarcoidosis were revealed. Histological examination found epithelioid cell granulomas consisting of mononuclear phagocytes and lymphocytes, without signs of necrosis. Granulomas with a proliferative component and hemorrhage sites were determined. Giant cells with cytoplasmic inclusions were detected - asteroid corpuscles and Schauman corpuscles. Non-caseous granulomas consisting of clusters of epithelioid histiocytes and giant Langhans cells surrounded by lymphocytes were detected in the lymph nodes of the lung roots. Hamazaki-Wesenberg corpuscles inside giant cells were found in the zones of peripheral sinuses of lymph nodes. In the lumen of the bronchi, there was found fully exfoliated epithelium, mucus. Granulomas are mainly observed subendothelially on the mucous membrane, without caseous necrosis. Histological examination of the cardiovascular system revealed fragmentation of some cardiomyocytes, cardiomyocyte focal hypertrophy along with moderate interstitial edema, erythrocyte sludge. Zones of small focal sclerosis were determined. The vessels of the microcirculatory bed are anemic, with hypertrophy of the walls in small arteries and arterioles. Virological examination of the sectional material in the lungs revealed SARS-CoV-2 RNA. Conclusion. Based on the data of medical documentation and the results of a post-mortem examination, it follows that the cause of death of the patient R.A, 50 years old, was a new coronavirus infection COVID-19 that resulted in bilateral total viral pneumonia. Сo-morbidity with competing diseases such as lung sarcoidosis and cardiovascular diseases aggravated the disease course, led to the development of early ARDS and affected the lethal outcome.

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Patient A.I., 58 years old, on September 6, 2022 was hospitalized within several hours in the infectious diseases department of the Novocheboksarskaya City Hospital of the Ministry of Health of Chuvashia. The patient in serious condition was admitted being accompanied by ambulance team, according to his son, from the night of 09/05/2022 until the afternoon of 09/06/2022 the patient complained of hectic temperature, diffuse pain in the abdominal cavity. In addition, the patient noted cough, feeling of air lack. As a result, an ambulance was called in. At admission, computed tomography revealed signs of bilateral viral interstitial pneumonia, with a lesion area of ​​51% and areas of consolidation. The diagnosis of COVID-19 was confirmed by PCR in a nasopharyngeal swab. History: Dyscirculatory encephalopathy of degrees 1-2, arterial hypertension, chronic indurative pancreatitis. Objective examination: on admission the body temperature was 38.8C. SaO2 - 56%. Blood pressure - 93/50 mm Hg. Art. Deep palpation revealed diffuse soreness and tension in the muscles of the anterior abdominal wall. The assessment of the condition on the NEWS2 scale comprised 11 points. Treatment was started, but a sudden death occurred. A clinical diagnosis was made: a new coronavirus infection COVID-19, virus verified. Competing disease: Acute parapancreatitis. Abscess of the mesentery of the small intestine. Complications of the underlying disease: Bilateral viral interstitial pneumonia. Acute respiratory distress syndrome. Septicemia (SOFA-2 points, procalcitonin=2 ng/ml). Post-mortem sectional examination revealed signs of viral-bacterial pneumonia. In the brain - pericellular and perivascular edema, heart - prominent edema of the interstitium, muscle fibers fragmented, kidneys - necronephrosis, pancreas - periductal, interlobular and intralobular sclerosis of the pancreas, between the islets of neutrophilic infiltrates. Hyperplasia was noted in the lymphoid and hematopoietic tissue, vasculitis, signs of interstitial inflammation in the parenchymal organs were determined. According to the results of microbiological examination of lung tissue, abundant growth of Klebsiella pneumoniae was found. Conclusion. The cause of death of the patient A.I. 58 years old was a novel coronavirus infection Covid-19, which caused bilateral viral pneumonia, in parallel with bacterial microflora, complicated by acute respiratory failure. There was also a generalized spread of infection with developed septicemia and multiple organ failure (pulmonary, cerebral, renal).

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