SARS-CoV-2 Related Deaths in Routine Forensic Autopsy Practice: Histopathological Patterns

Abstract

“Severe acute respiratory syndrome” (SARS) due to Coronavirus (SARS-CoV) infection is a known cause of death. Sometimes demise can occur unexpectedly in apparently previous healthy individual after a brief period of trivial flue-like symptoms. In this dobtfull cases the forensic pathologist could be requested to define cause of death occurred outside hospital. In this report the authors describe two thorough autopsied cases of SARS-CoV-2 related deaths occurred suddenly at home and not preceded by hospitalization, highlighting associated histopathologic patterns and correlating them to pathophysiology of viral infection.

More than Pneumonia: Distinctive Features of SARS-Cov-2 Infection. From Autopsy Findings to Clinical Implications: A Systematic Review

“…In 11/32 papers, hematoxylin and eosin stain was integrated with additional stains [ 18 , 24 , 34 , 36 , 39 , 40 , 45 , 49 , 50 , 53 , 57 ]. Histological analyses were completed with immunohistochemistry in 19/32 cases [ 11 , 18 , 19 , 24 , 33 , 34 , 35 , 38 , 47 , 48 , 49 , 52 , 53 , 55 , 56 , 57 ]. SARS-CoV-2 nucleocapsid protein monoclonal antibodies were used only in six papers [ 39 , 44 , 47 , 49 , 52 , 56 ].…”

“…Histological analyses were completed with immunohistochemistry in 19/32 cases [ 11 , 18 , 19 , 24 , 33 , 34 , 35 , 38 , 47 , 48 , 49 , 52 , 53 , 55 , 56 , 57 ]. SARS-CoV-2 nucleocapsid protein monoclonal antibodies were used only in six papers [ 39 , 44 , 47 , 49 , 52 , 56 ]. SARS-CoV-2 spike protein antibodies were not included in the reviewed studies.…”

“…Despite the involvement of cytokines and chemokines in the pathogenesis of COVID-19 disease, a panel for cytokines was proposed only in two studies [ 49 , 56 ]. A total of 12/32 studies completed the post-mortem investigation with electron microscopy [ 11 , 18 , 19 , 20 , 24 , 33 , 37 , 38 , 46 , 47 , 52 , 55 ]. The approach to post-mortem virologic analysis by real-time reverse transcription PCR resulted heterogeneous.…”

“…As previously described, evidence of acute tubular injury was described in COVID-19 patients; particularly, several modifications were detected in the proximal tubular epithelial cells such as variation of vacuolization size, loss of brush border, dilatation of the tubular lumen with cellular debris, and detachment of epithelium. All these modifications were related to viral toxicity [ 24 , 50 , 52 ]. In many cases, autolytic phenomena precluded the evaluation of acute kidney injury [ 20 , 43 ].…”

“…Arterionephrosclerosis, pre-existing pathological features of hypertension and diabetes, congestion of glomerular and peritubular capillaries and venules completed the renal findings [ 19 , 63 ]. Small fibrin platelet-rich thrombi in glomerular capillaries in association with severe injury of the endothelium were reported in a few cases as well as focal and sparse chronic inflammatory infiltrates [ 24 , 52 ]. Round viral particles were observed by electron microscopy in the tubular epithelium of the proximal tubules, rarely in the podocytes, and both individually or in aggregates in the cytoplasm or inside vesicles.…”