Introduction
World Health Organization reported COVID-19, caused by novel coronavirus
infection SARS-CoV-2, as pandemic in March 2020 which first
distinguished in Wuhan, China in December 2019 and rapidly spread
worldwide (1,2).
COVID-19 is associated with different clinical symptoms from mild
asymptomatic infection to severe systemic inflammation result in acute
respiratory distress syndrome (ARDS), myocarditis and severe COVID-19
sepsis (3-5).
Host hyper-inflammatory and hyperimmune responses in severe COVID-19
patients is associated with Diffuse alveolar damage (DAD), local
endothelial cell dysfunction severe thrombo-inflammatory processes,
vasculopathy and small vessel thrombosis (6,7). DAD is histological
characteristic for the acute phase of ARDS and defined as presence of
hyaline membranes (8).
Despite several studies focused on clinical manifestations of COVID-19,
there are fewer reports of autopsies have been released which contain
valuable information about immunopathology characteristic of COVID-19
(9). Due to multiple organ involvement in severe cases, increased
autopsies around world countries from different involved organs can help
to better understand the full aspects of the diseases such as COVID-19
(10).
To our knowledge this is the first report of histopathologic findings of
postmortem COVID-19 biopsies from Iran which is one of the outbreak
countries with more than 100000 confirmed cases.
Currently, the pathologic investigation has primarily focused on
respiratory, hematopoietic, and immune systems, whereas morphologic data
of liver and kidney injury are lacking.
In this study we aimed to investigate pathology of postmortem biopsy
including the lungs, liver, and kidneys in two patients.
Method
In this study we reported two patients admitted to hospital with fever
and respiratory symptoms. This study was approved by the Ethical
Committee of Iran University of Medical Sciences. Clinical symptoms and
past medical history were investigated. Laboratory tests and Computed
tomography (CT) of the chest were performed.
After permission from the patients’ families, postmortem needle core
biopsies were performed on visceral organs including the lungs, liver,
and kidneys shortly after death in a negative air isolation ward and
complete protection. The procedures were performed with ultrasound
guidance. Nasopharyngeal swabs for SARS-CoV-2 were positive (by rRT-PCR)
Case 1
The descent was a 57-year-old man without any past medical history
visited in respiratory clinic with fever, malaise and cough last week.
He had many sick contacts and nasopharyngeal swabs for SARS-CoV-2 were
positive (by rRT-PCR). Computed tomography (CT) of the chest revealed
mild infiltrations and he was not hypoxic on pulsoxymetry therefore he
was treated as outpatient. The symptoms became deteriorated within a
week and the patient admitted to intensive care unit due to difficulty
of breath, high fever and diffuse ground glass opacity with some crazy
paving and consolidation in chest CT scan (figure 1 a,b) (table 2).
Laboratory tests at the time of admission is shown in (table 1). The
patient was intubated because of severe hypoxemia. Different medications
were performed by medical treatment team during admission such as
antiviral drugs, Unfractionated heparin, IVIG, steroids, antibiotics and
plasma perfusion. Actemra (tocilizumab) was also administered after
nonreactive PPD skin test for tuberculosis due to elevated IL-6 level.
The descent went into shock and cardiac arrest.