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.