Complete post-mortem data in a fatal case of COVID-19: clinical, radiological and pathological correlations
Top Cited Papers
- 6 August 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in International journal of legal medicine
- Vol. 134 (6), 2209-2214
- https://doi.org/10.1007/s00414-020-02390-1
Abstract
A 75-year-old man presented to a French hospital with a 4-day fever after returning from a coronavirus disease-19 (COVID-19) cluster region. A reverse-transcription polymerase chain reaction test was positive for severe acute respiratory syndrome coronavirus-2 (SARS CoV-2) using a nasopharyngeal swab sample. After he returned home and a telephone follow-up, he was found deceased 9 days after first showing symptoms. Whole-body, non-enhanced, post-mortem computed tomography (PMCT) and a forensic autopsy were performed approximately 48 h after death, with sanitary precautions. The PMCT showed bilateral and diffuse crazy-paving lung opacities, with bilateral pleural effusions. Post-mortem virology studies detected the presence of SARS-CoV-2 (B.1 lineage) in the nasopharynx, plasma, lung biopsies, pleural effusion and faeces confirming the persistence of viral ribonucleic acid 48 h after death. Microscopic examination showed that severe lung damage was responsible for his death. The main abnormality was diffuse alveolar damage, associated with different stages of inflammation and fibrosis. This case is one of the first to describe complete post-mortem data for a COVID-19 death and highlights the ability of PMCT to detect severe involvement of the lungs before autopsy in an apparently natural death. The present pathology results are concordant with previously reported findings and reinforce the disease pathogenesis hypothesis of combined viral replication with an inappropriate immune response.Keywords
This publication has 28 references indexed in Scilit:
- A Novel Coronavirus from Patients with Pneumonia in China, 2019The New England Journal of Medicine, 2020
- Wave-CAIPI susceptibility-weighted imaging achieves diagnostic performance comparable to conventional susceptibility-weighted imaging in half the scan timeEuropean Radiology, 2020
- Epidemiology and Immune Pathogenesis of Viral SepsisFrontiers in Immunology, 2018
- Post-mortem CT imaging of the lungs: pathological versus non-pathological findingsLa radiologia medica, 2017
- How the SARS coronavirus causes disease: host or organism?The Journal of Pathology, 2005
- CD209L (L-SIGN) is a receptor for severe acute respiratory syndrome coronavirusProceedings of the National Academy of Sciences of the United States of America, 2004
- Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesisThe Journal of Pathology, 2004
- Lung pathology of severe acute respiratory syndrome (SARS): a study of 8 autopsy cases from SingaporeHuman Pathology, 2003
- The significance of the postmortem discovery of gastric contents in the air passagesForensic Science, 1975