Autopsy findings from the first known death from Severe Acute Respiratory Syndrome SARS-CoV-2 in Spain

Abstract

The new coronavirus SARS-CoV-2, first identified in Wuhan, China in December, 2019, can cause Severe Acute Respiratory Syndrome (SARS) with massive alveolar damage and progressive respiratory failure. We present the relevant autopsy findings of the first patient known to have died from COVID19 pneumonia in Spain, carried out on the 14^th of February, 2020, in our hospital (Hospital Arnau de Vilanova-Lliria, Valencia). Histological examination revealed typical changes of diffuse alveolar damage (DAD) in both the exudative and proliferative phase of acute lung injury. Intra-alveolar multinucleated giant cells, smudge cells and vascular thrombosis were present. The diagnosis was confirmed by reverse real-time PCR assay on a throat swab sample taken during the patient's admission. The positive result was reported fifteen days subsequent to autopsy.

Keywords: Autopsia; Autopsy; COVID-19; Daño alveolar difuso; Diffuse alveolar damage; SARS-CoV-2.

Figure 1

(A) Ground glass appearance in inferior lobes. (B) Gross image of lung section showing intense deep red colour and increased density.

Figure 2

DAD. (A) Lung parenchyma with haemorrhage, alveolar oedema and abundant hyaline membranes (H&E 100×). (B) Vascular thrombosis (H&E 200×). (C) Mono- and multinucleated cells with nuclear inclusions suggestive of viral cytopathic changes. (D) Immunohistochemistry: expression of CD68 in intraalveolar macrophages (400×) and of TTF1 in pneumocytes.

Figure 3

DAD. (A, B) Smudge cells (H&E 400×). (C) Myofibroblastic proliferation in alveolar walls (H&E 400×). (D) Squamous metaplasia in pneumocytes (H&E 400×).