Germany’s first COVID-19 deceased: a 59-year-old man presenting with diffuse alveolar damage due to SARS-CoV-2 infection

Abstract

Clinical characterization of COVID-19 (Corona Virus Disease 2019) is being performed worldwide to gain insights into the pathogenesis and course of the disease. Little is known regarding morphological findings, which are essential to understanding the unique features and pathomechanisms of the disease, from which one can identify possible new treatments. It has been shown that diffuse alveolar damage, signifying acute respiratory distress syndrome, is present together with atypical multinucleated cells in reported cases of the disease by Tian et al. (J Thorac Oncol 15:700-704, 2020). Macroscopic morphological findings in COVID-19 remain elusive to this day. Here, we report the case of the first German to die due to COVID-19. A detailed examination consisting of full-body computed tomography, autopsy, histology assessment, and viral assessment has been performed. The lungs of the deceased contained high concentrations of SARS-CoV-2 RNA and displayed the typical radiological signatures of COVID-19. Furthermore, a morphological pattern was found displaying hyperaemic areas interspersed by normally perfused areas affecting the whole lung. We also report a finding suggestive of micro-thrombotic events in the lung, which is compatible with the recently described coagulation changes and increased incidence of pulmonary artery embolisms seen in COVID-19 patients as reported by Wichmann et al. (Ann Intern Med, 2020). A broader study is needed to confirm these findings.

Anatomical and Pathological Observation and Analysis of SARS and COVID-19: Microthrombosis Is the Main Cause of Death

“…Importantly, the presence of platelet-fibrin thrombi in arterioles is consistent with coagulopathy, which seems to be very common in COVID-19 patients and should be one of the main goals of treatment [ 45 ]. The report of the first German who died of COVID-19 suggests that a microthrombotic event occurred in the lungs [ 46 ]. The pulmonary manifestations of 4 cases of fatal COVID-19 are introduced.…”

Died with or Died of? Development and Testing of a SARS CoV-2 Significance Score to Assess the Role of COVID-19 in the Deaths of Affected Patients

“…Results of the selection process are shown in Figure 1 , and detailed data for each case are reported in Table 1 . Fourteen studies describe multiple cases [ 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ], while 16 were case reports [ 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 ]. The highest sample size corresponded to 14 cases.…”

Pneumothorax and Pneumatocoele Formation in a Patient with COVID-19: a Case Report

“…Many of the descriptions of the histopathological features of COVID-19 infection found in the literature at the time of writing relate to autopsy (or post-mortem needle biopsy) findings in patients who died of severe disease-chiefly diffuse alveolar damage (DAD) in an acute respiratory distress syndrome (ARDS) setting [8][9][10][11], which itself has a number of infectious and non-infectious aetiologies. However, a recent paper has reported similar findings to ours in two lobectomy specimens from patients subsequently found to be COVID-19-positive, and therefore are judged likely to represent early changes of the disease, namely, vascular congestion, mild inflammation without a significant acute component and pneumocyte hyperplasia [12].…”