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Case Reports
. 2020 Nov;134(6):2209-2214.
doi: 10.1007/s00414-020-02390-1. Epub 2020 Aug 6.

Complete post-mortem data in a fatal case of COVID-19: clinical, radiological and pathological correlations

Mathilde Ducloyer  1   2 , Benjamin Gaborit  3 , Claire Toquet  4 , Louise Castain  5   6 , Antonin Bal  7   8 , Pierre Paul Arrigoni  9 , Raphaël Lecomte  3 , Renaud Clement  10 , Christine Sagan  4
Affiliations
Case Reports

Complete post-mortem data in a fatal case of COVID-19: clinical, radiological and pathological correlations

Mathilde Ducloyer et al. Int J Legal Med. 2020 Nov.

Abstract

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.

Keywords: Autopsy; COVID-19; Pathology; Post-mortem; Post-mortem computed tomography; SARS-CoV-2 coronavirus.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Post-mortem computed tomography and pulmonary parenchyma reconstruction. Axial (a) and sagittal (b) views showing diffuse, bilateral and panlobar ground-glass opacities associated with interlobular and intralobular septal thickening, subpleural consolidations and bilateral pleural effusions (asterisk). The anterior portions of both lungs were more likely to be spared
Fig. 2
Fig. 2
Microscopic findings in the lungs. (HES, magnification × 20). Diffuse alveolar damage in the acute (exudative) stage. a Hyaline membranes (arrow). b Hyaline membranes and alveolar vacuolated exudates (arrow)
Fig. 3
Fig. 3
Microscopic findings in the lungs. (HES, magnification × 20). Diffuse alveolar damage in a more organized stage. Note the enlargement of the alveolar septa, fibrin deposition and incorporation, intraalveolar exudates and a type-2 pneumocyte hyperplasia (arrow) representing patchy, interstitial chronic inflammation
See this image and copyright information in PMC

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