Clinicopathologic characteristics of severe COVID-19 patients in Mexico City: A post-mortem analysis using a minimally invasive autopsy approach

Abstract

Objective Describe the histological findings of minimally ultrasound-guided invasive autopsies in deceased patients with severe SARS-CoV-2 and compare the diagnostic yield with open autopsies. Design Observational post-mortem cohort study. Minimally invasive ultrasound-guided autopsies were performed in fourteen deceased patients with a confirmed diagnosis of SARS-CoV-2 pneumonia. Histological and clinical findings of lung, kidney, and liver tissue are described and contrasted with those previously reported in the literature. Setting Single-center COVID-19 reference center in Mexico City. Results Fourteen minimally invasive autopsies revealed a gross correlation with open autopsies reports: 1) Lung histology was characterized mainly by early diffuse alveolar damage (12/13). Despite low lung compliances and prolonged mechanical ventilation, the fibrotic phase was rarely observed (2/13). 2) Kidney histopathology demonstrated acute tubular injury (12/13), interstitial nephritis (11/13), and glomerulitis (11/13) as the predominant features 3) Liver histology was characterized by neutrophilic inflammation in all of the cases, as well as hepatic necrosis (8/14) despite minimal alterations in liver function testing. Hepatic steatosis was observed in most cases (12/14). SARS-CoV-2 positivity was widely observed throughout the immunohistochemical analysis. However, endothelitis and micro thrombosis, two of the hallmark features of the disease, were not observed. Conclusion Our data represents the largest minimally invasive, ultrasound-guided autopsy report. We demonstrate a gross histological correlation with large open autopsy cohorts. However, this approach might overlook major histologic features of the disease, such as endothelitis and micro-thrombosis. Whether this represents sampling bias is unclear.

SARS-CoV-2-Related Olfactory Dysfunction: Autopsy Findings, Histopathology, and Evaluation of Viral RNA and ACE2 Expression in Olfactory Bulbs

“…No complete negativity for all four post-mortem sampling was observed in any case (Table 1). The lung injury showed a clear pathological picture consistent with SARS-CoV-2 infection, as described in numerous previous studies [35,36]. The main lung pathological findings consisted of diffuse alveolar damage (DAD), in either the exudative phase, the organizing phase, or the fibrotic phase.…”

Histopathological impact of SARS-CoV-2 on the liver: Cellular damage and long-term complications

“…There have also been isolated cases with significant liver injury, leading to ALF[ 30 , 37 ]. However, it is more common to observe cases characterized by portal or lobular inflammation, which accounts for approximately 50% of all reported cases[ 28 , 32 , 41 - 44 ] (Table 1 ).…”

“…In patients with COVID-19 and liver involvement, it is common to observe lobular inflammation characterized by neutrophilic infiltration[ 41 , 44 ]. Additionally, increased Kupffer cells are often present, and occasionally eosinophils have been reported[ 28 , 31 , 44 ].…”

FSGS and COVID-19 in Non–African American Patients

“…In patients with coronavirus disease 2019 (COVID- 19) and clinical signs of kidney involvement, kidney biopsy usually shows features of acute proximal tubular injury consistent with the AKI clinical presentation. [1][2][3][4] However, FSGS, particularly of the collapsing variant, has been reported relatively frequently in African American (AA) patients with COVID-19. [5][6][7][8][9][10][11][12][13][14] Noncollapsing variants of FSGS have also been reported, albeit rarely.…”