Fatal pulmonary fibrosis: a post-COVID-19 autopsy case

Schwensen, Hanna Ferløv; Borreschmidt, Line Kristine; Storgaard, Merete; Redsted, Søren; Christensen, Steffen; Madsen, Line Bille

doi:10.1136/jclinpath-2020-206879

Cited by 79 publications

(83 citation statements)

References 20 publications

(18 reference statements)

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“…A previously reported case (80 years female subject) by Schwensen et al that had recovered from COVID‐19 and she had no history of pulmonary illness, however, she was suffering from bilateral lung fibrosis as a result of COVID‐19 which leads to her death 20 . Regarding cardiac involvement, it was reported that some COVID‐19 subjects suffered from myocarditis as a complication of COVID‐19 which was consistent with the finding of this study 21 .…”

Section: Discussionsupporting

confidence: 89%

Assessment and characterisation of post‐COVID‐19 manifestations

et al. 2020

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Background Post COVID‐19 symptoms and diseases appeared on many survivors from COVID‐19 which are similar to that of the post‐severe acute respiratory syndrome (SARS) fatigue. Hence, the study aims to investigate and characterize the manifestations which appear after eradication of the coronavirus infection and its relation to disease severity. Method 287 survivors from COVID‐19 were included in the study, each received a questionnaire divided into three main parts starting from subjects’ demographic data, data about the COVID‐19 status and other comorbidities of the subject, and finally data about post‐COVID‐19 manifestations. Response surface plots were produced to visualize the link between several factors. Results Only 10.8 % of all subjects have no manifestation after recovery from the disease while a large percentage of subjects suffered from several symptoms and diseases. The most common symptom reported was fatigue (72.8 %), more critical manifestations like stroke, renal failure, myocarditis, and pulmonary fibrosis were reported by a few percent of the subjects. There was a relationship between the presence of other comorbidities and severity of the disease. Also, the severity of COVID‐19 was related to the severity of post‐COVID‐19 manifestations. Conclusion The post‐COVID‐19 manifestation is largely similar to the post‐SARS syndrome. All subjects recovered from COVID‐19 should undergo long‐term monitoring for evaluation and treatment of symptoms and conditions that might be precipitated with the new coronavirus infection.

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Section: Discussionsupporting

confidence: 89%

Assessment and characterisation of post‐COVID‐19 manifestations

et al. 2020

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“…Furthermore, although COVID-19 is still recent, it is possible to infer that interstitial fibrosing could be an important future sequel in recovered patients. As revealed by Schwensen H F [51], destruction of lung parenchyma with fibrous organization and beginning of immature fibroblasts proliferation, was reported in an autopsy performed after clinical cure of COVID-19, indicating interstitial fibrosing as an important histomorphological sequel of this new disease.…”

Section: Pathologymentioning

confidence: 84%

Pulmonary pathology of ARDS in COVID-19: A pathological review for clinicians

Batah

Fabro

2021

Respiratory Medicine

246

206

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COVID-19 has quickly reached pandemic levels since it was first reported in December 2019. The virus responsible for the disease, named SARS-CoV-2, is enveloped positive-stranded RNA viruses. During its replication in the cytoplasm of host cells, the viral genome is transcribed into proteins, such as the structural protein spike domain S1, which is responsible for binding to the cell receptor of the host cells. Infected patients have initially flu-like symptoms, rapidly evolving to severe acute lung injury, known as acute respiratory distress syndrome (ARDS). ARDS is characterized by an acute and diffuse inflammatory damage into the alveolarcapillary barrier associated with a vascular permeability increase and reduced compliance, compromising gas exchange and causing hypoxemia. Histopathologically, this condition is known as diffuse alveolar damage which consists of permanent damage to the alveoli epithelial cells and capillary endothelial cells, with consequent hyaline membrane formation and eventually intracapillary thrombosis. All of these mechanisms associated with COVID-19 involve the phenotypic expression from different proteins transcription modulated by viral infection in specific pulmonary microenvironments. Therefore, this knowledge is fundamentally important for a better pathophysiological understanding and identification of the main molecular pathways associated with the disease evolution. Evidently, clinical findings, signs and symptoms of a patient are the phenotypic expression of these pathophysiological and molecular mechanisms of SARS-CoV-2 infection. Therefore, no findings alone, whether molecular, clinical, radiological or pathological axis are sufficient for an accurate diagnosis. However, their intersection and/or correlation are extremely critical for clinicians establish the diagnosis and new treatment perspectives.

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“…Since it has been reported in the literature that equal than other coronaviruses are responsible for producing pulmonary fibrosis [ 38 , 39 , 40 , 41 ], and that this has also been recognized as a sequel to acute respiratory distress syndrome (ARDS). Also, dyspnea related with COVID-19 can be associated with heart problems [ 42 , 43 ], so its origin should be investigated, and recovered patients should be followed up, since the extent of the complications is still unknown [ 44 ].…”

Section: Discussionmentioning

confidence: 99%

Persistence of COVID-19 Symptoms after Recovery in Mexican Population

Galván-Tejada

Herrera-García

Godina-González

et al. 2020

IJERPH

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The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the coronavirus disease (COVID-19), a highly contagious infectious disease that has caused many deaths worldwide. Despite global efforts, it continues to cause great losses, and leaving multiple unknowns that we must resolve in order to face the pandemic more effectively. One of the questions that has arisen recently is what happens, after recovering from COVID-19. For this reason, the objective of this study is to identify the risk of presenting persistent symptoms in recovered from COVID-19. This case-control study was conducted in one state of Mexico. Initially the data were obtained from the participants, through a questionnaire about symptoms that they had at the moment of the interview. Initially were captured the collected data, to make a dataset. After the pre-processed using the R project tool to eliminate outliers or missing data. Obtained finally a total of 219 participants, 141 recovered and 78 controls. It was used confidence level of 90% and a margin of error of 7%. From results it was obtained that all symptoms have an associated risk in those recovered. The relative risk of the selected symptoms in the recovered patients goes from 3 to 22 times, being infinite for the case of dyspnea, due to the fact that there is no control that presents this symptom at the moment of the interview, followed by the nausea and the anosmia with a RR of 8.5. Therefore, public health strategies must be rethought, to treat or rehabilitate, avoiding chronic problems in patients recovered from COVID-19.

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Fatal pulmonary fibrosis: a post-COVID-19 autopsy case

Cited by 79 publications

References 20 publications

Assessment and characterisation of post‐COVID‐19 manifestations

Assessment and characterisation of post‐COVID‐19 manifestations

Pulmonary pathology of ARDS in COVID-19: A pathological review for clinicians

Persistence of COVID-19 Symptoms after Recovery in Mexican Population

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