Postmortem Cardiopulmonary Pathology in Patients with COVID-19 Infection: Single-Center Report of 12 Autopsies from Lausanne, Switzerland.

Sabina Berezowska,Damien Maison,Eleonore Multone,Samuel Rotman,Pierre-Yves Bochud,Karine Lefort,Nathalie Piazzon,Daba-Rokhya Ndiaye,Dina Milowich,Mauro Oddo,Constantinos Petrovas,Nathalie Sala,Laurence De Leval,Chun-Yi Tsai,Kalliopi Ioannidou,Bettina Bisig

doi:10.3390/diagnostics11081357

Sabina Berezowska, Damien Maison + Show 14 more

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https://doi.org/10.3390/diagnostics11081357

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Journal: Diagnostics	Publication Date: Jul 28, 2021
Citations: 10	License type: CC BY 4.0

Affiliation: University of Lausanne

Abstract

We report postmortem cardio-pulmonary findings including detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in formalin-fixed paraffin embedded tissue in 12 patients with COVID-19. The 5 women and 7 men (median age: 73 years; range 35–96) died 6–38 days after onset of symptoms (median: 14.5 days). Eight patients received mechanical ventilation. Ten patients showed diffuse alveolar damage (DAD), 7 as exudative and 3 as proliferative/organizing DAD. One case presented as acute fibrinous and organizing pneumonia. Seven patients (58%) had acute bronchopneumonia, 1/7 without associated DAD and 1/7 with aspergillosis and necrotic bronchitis. Microthrombi were present in 5 patients, only in exudative DAD. Reverse transcriptase quantitative PCR detected high virus amounts in 6 patients (50%) with exudative DAD and symptom-duration ≤14 days, supported by immunohistochemistry and in-situ RNA hybridization (RNAscope). The 6 patients with low viral copy levels were symptomatic for ≥15 days, comprising all cases with organizing DAD, the patient without DAD and one exudative DAD. We show the high prevalence of DAD as a reaction pattern in COVID-19, the high number of overlying acute bronchopneumonia, and high-level pulmonary virus detection limited to patients who died ≤2 weeks after onset of symptoms, correlating with exudative phase of DAD.

Highlights

During the last one and a half years, Coronavirus disease 2019 (COVID-19) has emerged as a worldwide pandemic, caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
We report postmortem cardio-pulmonary findings including detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in formalin-fixed paraffin embedded tissue in 12 patients with COVID-19
We show the high prevalence of diffuse alveolar damage (DAD) as a reaction pattern in COVID-19, the high number of overlying acute bronchopneumonia, and high-level pulmonary virus detection limited to patients who died ≤2 weeks after onset of symptoms, correlating with exudative phase of DAD

Summary

Introduction

During the last one and a half years, Coronavirus disease 2019 (COVID-19) has emerged as a worldwide pandemic, caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease mainly affects the lungs, most often leading to death due to acute respiratory distress syndrome (ARDS). Taken into account the high number of deaths resulting from the disease worldwide (>3,404,000 until 19 May 2021) [2], documentation of the histological lesions is still relatively limited, with a disproportionately low number of autopsy studies. We document our findings in consecutive autopsies of patients who died of COVID-19 during the first wave, with focus on pulmonary and cardio-vascular pathology including viral detection in formalin-fixed paraffin embedded (FFPE) tissue. We show the high prevalence of DAD as a reaction pattern in COVID-19, the high number of overlying acute bronchopneumonia, and high-level pulmonary virus detection limited to patients who died ≤2 weeks after onset of symptoms, correlating with exudative phases of DAD

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