一名75岁的男子在从冠状病毒病-19(COVID-19)聚集区返回后,因发烧4天来到一家法国医院。使用鼻咽拭子样本进行的严重急性呼吸综合征冠状病毒2(SARSCoV-2)的逆转录聚合酶链反应测试呈阳性。他回家后电话跟进,他在首次出现症状9天后被发现死亡。全身,非增强,死后大约48小时进行了尸检(PMCT)和法医尸检,卫生预防措施。PMCT显示双侧和弥漫性疯狂铺路肺混浊,双侧胸腔积液。死后病毒学研究发现鼻咽中存在SARS-CoV-2(B.1谱系),等离子体,肺活检,胸腔积液和粪便证实病毒核糖核酸在死亡48小时后持续存在。显微镜检查显示,严重的肺损伤是他死亡的原因。主要异常为弥漫性肺泡损伤,与炎症和纤维化的不同阶段相关。该病例是最早描述COVID-19死亡的完整验尸数据的病例之一,并强调了PMCT在尸检之前检测到肺部严重受累的能力。目前的病理结果与先前报道的发现一致,并加强了病毒复制与不适当免疫反应相结合的疾病发病机理假说。
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.