Oral lesions with immunohistochemical evidence of Sars‐CoV‐2 in swab‐negative post‐COVID syndrome

Abstract

ObjectivesGrowing evidence exists about post‐COVID condition/syndrome as sequelae of Sars‐CoV‐2 infection in healed patients, possibly involving the lungs, brain, kidney, cardiovascular and neuromuscular system, as well the persistency of taste dysfunction. Such symptoms develop during or after infection and continue for more than 12 weeks with pathogenesis related to virus persistency but variable by organs or systems.Materials and MethodsWe recently observed six patients recovered from COVID‐19 and with negative RT‐PCR testing, showing oral mucosa lesions (mainly ulcers) overlapping those occurring in the acute phase, persisting up to 20 days and thus needing a biopsy with histological investigation and spike protein evaluation by immunohistochemistry.ResultsWe found epithelial ulceration, inflammatory infiltrate, vessels with increased diameter and flattened endothelium but no thrombi formation; also, we found a weak epithelial SARS‐CoV‐2 positivity limited to the basal/spinosum layers, progressively decreasing toward the periphery, and the intraepithelial lymphomonocytes, endothelium, and perivascular pericytes too.ConclusionsOur findings provide evidence that SARS‐CoV‐2 can persist, as for other organs/systems, also in the oral epithelium/mucosa after the acute phase and can be responsible for lesions, although by a pathogenetic mechanism that should be better defined but certainly referable as the oral mucosa counterpart of post‐COVID syndrome.

Oral manifestations of COVID-19 in unvaccinated patients: a cross-sectional study

“…With ACE2 expression, oral tissues could facilitate direct SARS-CoV-2 invasion, contributing to its pathogenesis and potentially enhancing human-to-human transmission rates [6,16]. Limongelli et al [18]. present evidence that SARS-CoV-2 may persist in the oral epithelium/mucosa beyond the acute phase, potentially leading to lesions.…”