Histopathologic findings in COVID-19 Autopsies from IRAN: A
comprehensive report of laboratory, chest Computed tomography (CT) and
morphology findings
Abstract
Background: Coronavirus disease 2019 (COVID-19) is associated with
diffuse alveolar damage (DAD) and coagulopathy in severe ill patients.
Objective: To better understand and disease management, we investigated
postmortem needle biopsies of lung, liver, and kidney pathologic changes
along with clinical course, hematologic and imaging findings in two
COVID-19 decedents. Patients and method We examined pathology of two
patients with confirmed positive SARS-CoV-2 test died from respiratory
failure. Computed tomography (CT) of the chest, Clinical and laboratory
findings were investigated. Postmortem needle biopsies of lung, liver,
and kidney were performed with complete protection. Results: The
patients died from acute respiratory distress syndrome (ARDS). One of
the patients was 56-year old man without any predisposing factor and the
other (83-year old man) had hypertension, diabetes mellitus and renal
failure. The patients had lymphopenia, elevated C-Reactive Protein
(CRP), ferritin and D-Dimer. Axial CT images show diffuse ground glass
opacity with some crazy paving and consolidation. The main pathologic
finding of lungs revealed DAD. Intravascular micro-thrombi were detected
despite anticoagulant prophylaxis. Renal autopsy demonstrated acute
tubulointerstitial nephritis (ATIN) with tubular epithelium attenuation.
Liver biopsy was consisted of lobular and portal inflammation and
steatosis Conclusion This study emphasis that diffuse alveolar damage
and microvascular pulmonary thrombosis in SARS-CoV-2 patients caused by
either direct viral cytopathic effect or host immune and inflammatory
reaction. Due to severe hypoxemia in COVID-19 patients suffering ARDS,
appropriate oxygen support and anticoagulation therapy with strict
monitoring is recommended