Complete post-mortem data in a fatal case of COVID-19: clinical, radiological and pathological correlations

Abstract

A 75-year-old man presented to a French hospital with a 4-day fever after returning from a coronavirus disease-19 (COVID-19) cluster region. A reverse-transcription polymerase chain reaction test was positive for severe acute respiratory syndrome coronavirus-2 (SARS CoV-2) using a nasopharyngeal swab sample. After he returned home and a telephone follow-up, he was found deceased 9 days after first showing symptoms. Whole-body, non-enhanced, post-mortem computed tomography (PMCT) and a forensic autopsy were performed approximately 48 h after death, with sanitary precautions. The PMCT showed bilateral and diffuse crazy-paving lung opacities, with bilateral pleural effusions. Post-mortem virology studies detected the presence of SARS-CoV-2 (B.1 lineage) in the nasopharynx, plasma, lung biopsies, pleural effusion and faeces confirming the persistence of viral ribonucleic acid 48 h after death. Microscopic examination showed that severe lung damage was responsible for his death. The main abnormality was diffuse alveolar damage, associated with different stages of inflammation and fibrosis. This case is one of the first to describe complete post-mortem data for a COVID-19 death and highlights the ability of PMCT to detect severe involvement of the lungs before autopsy in an apparently natural death. The present pathology results are concordant with previously reported findings and reinforce the disease pathogenesis hypothesis of combined viral replication with an inappropriate immune response.

Neurological Sequelae in Patients with COVID-19: A Histopathological Perspective

“…Based on the clinical studies and the limited neuropathological data, CNS histopathology encompasses hypoxic/ischemic encephalopathy, activated microglial cells with variable infiltration of perivascular T lymphocyte, cerebrovascular diseases, AHNE, encephalitis/meningitis, acute myelitis, demyelinating disorders, and PNS involvement [ 21 , 68 , 71 , 73 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 , 111 , 112 , 113 , 114 , 115 ], with histologically documented lesions in some studies [ 6 , 11 , 68 , 69 , 71 , 72 , 73 ].…”

COVID-19 lungs in post-mortem computed tomography

“…described diffuse bilateral crazy-paving patterns, i.e. GGO in areas of reticular densification of the lungs in one fatal case of COVID-19 in PMCT [ 4 ]. In another case with COVID-19 positive PMCT signs, Leth et al.…”

A Pictorial Review of the Role of Imaging in the Detection, Management, Histopathological Correlations, and Complications of COVID-19 Pneumonia

“…Few studies have correlated imaging findings in severe cases of COVID-19 pneumonia with histopathological findings [ 162 , 163 , 164 , 165 , 166 , 167 ]. This issue was investigated especially in case reports and case series mainly based on CT features described in ante-mortem or post-mortem examinations [ 163 , 164 , 165 , 166 ].…”