Autopsy Findings in 32 Patients with COVID-19: A Single-Institution Experience

Abstract

Background A novel coronavirus, SARS-CoV-2, was identified in Wuhan, China in late 2019. This virus rapidly spread around the world causing disease ranging from minimal symptoms to severe pneumonia, which was termed coronavirus disease (i.e., COVID). Postmortem examination is a valuable tool for studying the pathobiology of this new infection. Methods We report the clinicopathologic findings from 32 autopsy studies conducted on patients who died of COVID-19 including routine gross and microscopic examination with applicable special and immunohistochemical staining techniques. Results SARS-CoV-2 infection was confirmed by nasopharyngeal RT-PCR in 31 cases (97%) and by immunohistochemical staining for SARS-CoV-2 spike-protein in the lung in the remaining 1 case (3%). The ethnically diverse cohort consisted of 22 males and 10 females with a mean age of 68 years (range: 30–100). Patients most commonly presented with cough (17 [55%]), shortness of breath (26 [81%]), and a low-grade fever (17 [55%]). Thirty-one (97%) of the patients had at least 1 comorbidity (mean = 4). Twenty-eight patients (88%) had widespread thromboembolic disease, as well as diffuse alveolar damage (30 [94%]), diabetic nephropathy (17 [57%]) and acute tubular injury. Patterns of liver injury were heterogeneous, featuring 10 (36%) with frequent large basophilic structures in sinusoidal endothelium, and increased immunoblast-like cells in lymph nodes. Conclusion This series of autopsies from patients with COVID-19 confirms the observation that the majority of severely affected patients have significant pulmonary pathology. However, many patients also have widespread microscopic thromboses, as well as characteristic findings in the liver and lymph nodes.

Chloroquine may induce endothelial injury through lysosomal dysfunction and oxidative stress

“…In this regard, the high mortality of severe COVID-19 has been related to micro- or macrothrombosis, i.e. to endothelial cell injury ( Ackermann et al, 2020 ; Elsoukkary et al, 2020 ; Philipponnet et al, 2020 ). Although chloroquine was known to induce glycolipid deposits in lysosomes, the impact of this phenomenon on endothelial cell function had not been explored.…”

Pulmonary Pathology of COVID-19 Following 8 Weeks to 4 Months of Severe Disease: A Report of Three Cases, Including One With Bilateral Lung Transplantation

“… 25 In another, the range was 1 to 58 days (median, 21 days). 23 A series of 30 “minimally invasive autopsies” included six patients with duration of illness listed as 63, 68, 75, 63, 71, and 82 days. 6 Not unexpectedly, the most striking degree of tissue damage has consistently been reported in the lungs.…”

Investigations of Pathologists as a Key to Understanding Coronavirus Disease 2019

“…A large autopsy study of 32 cases by Salvatore et al [10] from the New York, one of the epicentres of the pandemic, showed the diversity of pathologic findings: besides diffuse alveolar damage, this cohort confirmed the increased frequency thromboembolisms in multiple organ systems. Furthermore, thanks to the diligent work-up of the cases, distinct histopathological patterns in lymph nodes and the liver were observed.…”