COVID-19 Autopsy Pathology Findings

Summary

In this detailed presentation, pathologist Dr. Andrea Gilbert shares autopsy findings of a patient who died from COVID-19. The patient, a young to middle-aged woman with obesity and possible asthma, presented with severe respiratory failure and was diagnosed with acute respiratory distress syndrome (ARDS) due to the virus. Autopsy revealed extensive lung damage with large areas of consolidation, pulmonary edema, and desquamation of pneumocytes. Notable was the presence of diffuse alveolar damage, perivascular lymphocytic infiltrates suggestive of vasculitis, and rare multinucleated giant cells. The heart showed signs of takotsubo cardiomyopathy and edema without evidence of viral myocarditis. Acute kidney injury was also observed. Dr. Gilbert emphasizes the importance of ventilator use in severe cases and cautions against the misuse of hydroxychloroquine. This comprehensive analysis provides valuable insights into the pathogenesis of COVID-19, highlighting the need for serious consideration of the disease, even among younger individuals.

Takeaways

• 🧬 The patient, a young to middle-aged woman with obesity and possible asthma, presented with COVID-19 and experienced severe respiratory failure, leading to acute respiratory distress syndrome (ARDS) and death.
• 🩺 Clinically, the patient showed signs of heart dysfunction with elevated cardiac markers, low oxygen levels, and a diagnosis of septic shock and cardiogenic shock, indicative of the multi-system impact of COVID-19.
• 🔍 Autopsy findings revealed extensive lung damage with large areas of consolidation, severe pulmonary edema, and desquamation, which are consistent with the patient's clinical hypoxia and respiratory distress.
• 🔬 Microscopic examination showed evidence of viral cytopathic effects, suggesting direct damage to lung cells by the virus, and the presence of multinucleated giant cells and hyaline membranes, characteristic of diffuse alveolar damage.
• 🫀 The heart showed no signs of ischemic injury, but there was evidence of a rare congenital condition affecting the right atrium, which may have contributed to cardiac abnormalities during the severe lung infection.
• 🩸 Peripheral blood smear showed atypical lymphocytes and a left shift, indicating the body's active response to infection, but no clear evidence of thrombosis.
• 💊 The patient had received hydroxychloroquine, a drug with a narrow therapeutic window, which requires close monitoring due to its potential toxicity.
• 🧠 The neuropathology findings were not discussed in the script, but the presenter mentioned presenting such findings in other episodes, highlighting the multi-organ impact of the virus.
• 📉 The kidneys showed no signs of primary infection or inflammatory disorder but had focal areas of acute tubular injury, potentially linked to severe hypoxia from the lung injury.
• ⚖️ The autopsy findings underscore the severe impact of COVID-19 on the respiratory system and the importance of understanding the pathogenesis of the disease for clinical management.
• ⚠️ The presenter emphasized the importance of not dismissing the use of ventilators in severe cases, as they are often necessary to prevent patients from drowning in their own fluids due to lung failure.

Q & A

What is the significance of sharing autopsy results for a patient who was positive for COVID-19?

The significance lies in the limited pathology data available for COVID-19. Autopsy results can provide valuable insights into the disease's impact on the body, which is crucial for clinicians in ICUs and emergency departments to better understand and combat the virus.

What was the patient's clinical presentation before her death?

The patient, a young to middle-aged woman, presented with a one-week history of fever, cough, and dyspnea (difficulty breathing). She had obesity and a possible history of asthma. In the emergency room, she experienced severe respiratory failure and hypotension.

What was observed in the patient's lung during the autopsy?

The lungs were heavy, boggy, and consolidated, with a firm or rubbery consistency instead of the normal spongy feel due to air. There was significant pleural edema and areas of consolidation. Microscopically, there was diffuse consolidation, pulmonary edema, and desquamation of pneumocytes.

What is the 'viral cytopathic effect' mentioned in the autopsy?

Viral cytopathic effect refers to the changes in the appearance of cells that have been infected by a virus. Infected cells often appear abnormal and different from healthy cells, which can be observed under a microscope.

What was the patient's cardiac condition?

The patient was diagnosed with reverse takotsubo cardiomyopathy, also known as 'broken heart syndrome,' which is not an ischemic type of cardiomyopathy. She also experienced cardiogenic shock and had elevated cardiac markers indicating concern about her heart function.

What was found regarding the patient's kidney condition?

The patient had acute kidney injury with evidence of acute tubular injury and necrosis, which could be related to severe hypoxia due to her lung injury.

What is the role of hydroxychloroquine in the treatment of COVID-19 as mentioned in the script?

Hydroxychloroquine was mentioned as a treatment the patient received. However, it's noted that it's not a benign drug and requires close monitoring due to its narrow therapeutic window, meaning the margin between effective dosage and toxicity is small.

What was the patient's vascular condition as observed during the autopsy?

There was a perivascular lymphocytic infiltrate observed around the blood vessels in the lungs, which in some areas resembled vasculitis. However, the patient tested negative for ANCA, which is typically associated with vasculitis.

What are the implications of the autopsy findings for the understanding of COVID-19 pathology?

The autopsy findings provide detailed pathological insights into the effects of COVID-19, particularly the extensive lung damage, which aligns with the clinical presentation of acute respiratory distress syndrome (ARDS). It also suggests potential cardiac and renal involvement.

What is the importance of not jumping to conclusions about micro thrombi in COVID-19 cases?

The importance is to avoid misinterpretation of findings that could lead to inappropriate treatment. Micro thrombi can occur in the context of diffuse alveolar damage with acute lung injury, not necessarily indicating a systemic prothrombotic state.

What was the patient's age and medical history?

The patient was a young to middle-aged woman with a past medical history significant for obesity and a questionable history of possible asthma.

What was the patient's condition that led to the autopsy?

The patient passed away due to complications from COVID-19 infection, which resulted in acute respiratory distress syndrome (ARDS), septic shock, cardiogenic shock, and acute kidney injury.