Inside the lungs of COVID-19 disease

Abstract

In the setting of the coronavirus disease 2019 (COVID-19) pandemic, only few data regarding lung pathology induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is available, especially without medical intervention interfering with the natural evolution of the disease. We present here the first case of forensic autopsy of a COVID-19 fatality occurring in a young woman, in the community. Diagnosis was made at necropsy and lung histology showed diffuse alveolar damage, edema, and interstitial pneumonia with a geographically heterogeneous pattern, mostly affecting the central part of the lungs. This death related to COVID-19 pathology highlights the heterogeneity and severity of central lung lesions after natural evolution of the disease.

Keywords: COVID-19; Diffuse alveolar damage; Interstitial pneumonia; Post-mortem; SARS-CoV-2.

Fig. 1

a Upper right lobe lung parenchyma showing geographical heterogeneity of pulmonary lesions, with two samples of lung parenchyma in contact. The central sample is at the bottom presenting diffuse filling of the alveolar space with fibrin and the peripheral sample is at the top (black star) with clear open alveolar space. Arrow indicate visceral pleura (acid fuchsin–orange G stain (SFOG), × 20). b Magnification of diffuse filling of the alveolar space with fibrin (acid fuchsin–orange G stain (SFOG), × 100). c Hyaline membranes (black arrows) indicating diffuse alveolar damage (hematoxylin and eosin, × 100)

Fig. 2

a Moderate type II pneumocytes hyperplasia (black arrows) with some desquamation (pankeratin, × 200). b Unaffected area of lung parenchyma with normal pneumocytes I and II morphology (pankeratin, × 200). c Moderate intra-alveolar macrophages (CD68, × 200). d Moderate amount of T lymphocytes infiltration in the interstitium (CD3, × 100)