Postmortem Lung Findings in a Patient With Asthma and Coronavirus Disease 2019

Abstract

Asthma is increasingly recognized as an underlying risk factor for severe respiratory disease in patients with coronavirus disease 2019 (COVID-19), particularly in the United States. Here, we report the postmortem lung findings from a 37-year-old man with asthma, who met the clinical criteria for severe acute respiratory distress syndrome and died of COVID-19 less than 2 weeks after presentation to the hospital. His lungs showed mucus plugging and other histologic changes attributable to asthma, as well as early diffuse alveolar damage and a fibrinous pneumonia. The presence of diffuse alveolar damage is similar to descriptions of autopsy lung findings from patients with severe acute respiratory syndrome coronavirus and Middle East respiratory syndrome coronavirus, and the absence of a neutrophil-rich acute bronchopneumonia differs from the histologic changes typical of influenza. The relative contribution of mucus plugging to his hypoxemia is unknown.

Keywords: COVID-19, coronavirus disease 2019; DAD, diffuse alveolar damage; HD, hospital day; MERS, Middle East respiratory syndrome; SARS, severe acute respiratory syndrome; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; asthma; coronavirus; diffuse alveolar damage.

Figure 1

Mucus plugs. Cut surface of the lung shows a thick intraluminal exudate within bronchi (gross image).

Figure 2

Diffuse alveolar damage. Diffuse alveolar damage is characterized by epithelial and endothelial injury, resulting in the formation of hyaline membranes that outline distal alveolar airspaces (hematoxylin- and eosin-stained slide; original magnification, ×180).

Figure 3

Fibrinous pneumonia. Distal alveolar spaces are focally filled with a fibrinous exudate accompanied by an inflammatory infiltrate, composed mainly of mononuclear inflammatory cells (hematoxylin- and eosin-stained slide; original magnification, ×176).