This paper describes three autopsy cases with postmortem diagnosis of SARS-CoV-2 infection, with detailed macroscopic examination as well as advanced microscopic studies of organ tissues collected using hematoxylin-eosin stains and immunohistochemical markers. Two of the cases were admitted briefly in the County Clinical Emergency Hospital of Sibiu, and one was found deceased at his home address. All three autopsies were completed at the County morgue, in the COVID-19 restricted area, using complete protective equipment. The lungs of the patients seemed to be the center organ of invasion and pathogenesis of the novel coronavirus with diffuse areas of condensation, subpleural retraction zones but with different aspect of the classic bacterial bronchopneumonia. Microscopic evaluation revealed viral cytopathic effect of type II pneumocytes with a couple of cells that presented cytoplasmic and nuclear inclusions and who tend to form clusters mimicking multinucleated giant cells. Hyaline membranes and destruction of the alveolar wall as well as microthrombi formation within the small blood vessels were constantly found in almost all our three cases. The spleen had sustained white pulp atrophy with absence of lymphoid follicles. There were no microscopic signs of viral infection on the myocardium or the other organs.

Background The cutaneous manifestations of SARS-CoV-2 have been insufficiently covered in the literature. Methods We retrospectively analyzed 39 patients, admitted in our hospital, all with confirmed SARS-CoV-2 infection, patients that associated during the hospitalization or in the convalescence period various skin manifestations. Results We admitted in our hospital from March 23 until September 12, 2020, 39 cases of SARS-CoV-2 infected patients which were identified with intra-infectious rash or with lesions ofcutaneous vasculitis during convalescence. The most common cutaneous manifestation are erythematous and erythematous papular rash. 27 of the 39 documented patients had anosmia (69.2%), 26 patients had ageusia (66.7%), 34 patients presented pneumonia (87.2%), 24 patients had intra-infectious enterocolitis (61.5%). Skin biopsies were rarely performed in these patients. Furthermore, we are reporting two performed biopsies with the histopathological and immunohistochemistry changes of this selected cases of erythematous rash and erythema multiforme-like lesions. Both skin biopsies reveal an early fibrous remodeling of the dermis, suggesting similar changes that occur in the lungs or in other tissues in this disease. Conclusions The correlation of the skin lesions in SARS-CoV-2 infection with anosmia, ageusia and enteritis does not seem to be accidental, but associated with a similar response to ACE2 receptor expression in these tissues.

Myocardial injury in patients with SARS-CoV-2 infection may be attributed to the presence of the virus at the cellular level, however, it may also be secondary to other diseases, playing an essential role in the evolution of the disease. We evaluated 16 patients who died because of SARS-CoV-2 infection and analyzed the group from both clinical and pathological points of view. All autopsies were conducted in the Sibiu County morgue, taking into consideration all the national protocols for COVID-19 patients. Of the 16 autopsies we performed, two were complete, including an extensive examination of the cranial cavity. In our study, the cardiac injury was primarily cumulative. Chronic cardiac injuries included fatty infiltration of the myocardium in five cases, fibrosis in 11 cases, and coronary atherosclerosis in two cases. Among the cases with evidence of acute cardiovascular injuries, inflammatory lymphocytic infiltrate was observed in nine cases, subepicardial or visceral pericardial neutrophil-rich vascular congestion in five cases, and venous thrombosis in three cases. Acute ischemia or myocytic distress was identified by vacuolar degeneration in four cases; areas of undulated and/or fragmented myocardial fibers, with eosinophilia and nuclear pyknosis with or without enucleation of the myocytes in nine cases; and in one case, we observed a large area of myocardial necrosis. Immunohistochemical criteria confirmed the presence of the SARS-CoV-2 antigen at the level of the myocardium in only two cases. Comorbidities existing prior to SARS-CoV-2 infection associated with systemic and local inflammatory, thrombotic, hypoxic, or immunological phenomena influence the development of cardiac lesions, leading to death.