Coronavirus Disease 2019: Associated Multiple Organ Damage

Abstract

A 56-year-old man presented a particularly severe and multisystemic case of coronavirus disease 2019 (COVID-19). In addition to the common lung and quite common pulmonary embolism and kidney injuries, he presented ocular and intestinal injuries that, to our knowledge, have not been described in COVID-19 patients. Although it is difficult to make pathophysiological hypotheses about a single case, the multiplicity of injured organs argues for a systemic response to pulmonary infection. A better understanding of physiopathology should feed the discussion about therapeutic options in this type of multifocal damage related to severe acute respiratory syndrome coronavirus 2.

Keywords: COVID-19; SARS-CoV-2; brain magnetic resonance imaging; microthrombi; severe acute respiratory syndrome.

Figure 1.

Lungs and gut are shown. (a) Initial chest computed tomography (CT) scan: extensive bilateral ground-glass opacities and alveolar consolidation, with peripheral and subpleural predominance, in keeping with a severe coronavirus disease 2019 (COVID-19). No evidence of pulmonary embolism was present at that time. (b) Abdominal CT: bowel wall thickening with severe hypoenhancement (see Figure 2b, arrows) and significant mesenteric intravenous air (see Figure 2b, stars), suggestive of mesenteric ischemia. (c) Small intestine histology: thrombosed small blood vessels in submucosal bowel at higher magnification (stars, hematoxylin and eosin stain ×200).

Figure 2.

Brain and eyes are shown. (a and 2b). Brain magnetic resonance imaging (MRI): axial fluid-attenuated inversion recover [FLAIR]; a), axial T1 after contrast weighted MR images (b). Cerebral MRI (a and b): bipallidal (arrow), right thalamic (arrow head), both internal capsules (star) lesions, hyperintense on FLAIR (a), with areas of contrast enhancement on T1 after contrast (b) corresponding to blood-brain barrier leakage. (c) Orbital MRI: moderate global thickening of the ocular bulbs wall (stars), with several focal nodular foci predominating on the right side probably of choroidal origin (arrows). (d) Fundus examination showing peripheral vitreous haze and condensations associated with vascular sheath.