Coronavirus disease 2019 in a patient with pulmonary fibrosis and emphysema: An autopsy report

Abstract

Various diseases (e.g., hypertension and diabetes) are risk factors for the exacerbation of coronavirus 2019 (COVID-19). Patients with chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD) tend to develop severe COVID-19. Patients with severe COVID-19 present with acute respiratory distress syndrome (ARDS), and many COVID-19-related ARDS survivors eventually develop fibrosis. However, the appropriate management of patients with COVID-19 and ILD and post-COVID-19 ILD remains unclear. Thus, a better understanding of the pathology that exacerbates COVID-19 in patients with ILD is needed. We report the autopsy results of a patient with COVID-19 and combined pulmonary fibrosis and emphysema, whose lung organization and fibrosis progressed after the acute phase of infection. Histopathological findings suggest that fatal pulmonary fibrosis persists after the negative conversion of SARS-CoV-2. Elucidating the cause of death by autopsy may help determine therapeutic strategies in patients with COVID-19 and ILD. Vaccination and early administration of anti-inflammatory drugs or antifibrotic agents may be crucial for preventing disease progression and fatal lung fibrosis. This report aims to clarify the histopathological features of COVID-19 in patients with ILD via autopsy and discuss treatment strategies.

Keywords: Acute respiratory distress syndrome; Autopsy; COVID-19; Interstitial lung disease; SARS-CoV-2.

Fig. 1

Antemortem chest radiograph and CT scan findings. (A, B) CT scan on Day 4 reveals emphysema in both the upper and middle lobes and ground glass opacities and fibrosis mainly in the bilateral lower lobes. (C) Chest radiograph on Day 6 shows hyperlucency in the right upper lung field and ground glass opacities in both lower lung fields. CT, computed tomography.

Fig. 2

Clinical course of the patient.

Fig. 3

A chest computed tomography scan 2 hours after death shows (A) worsened emphysema in the right upper lobe and (B) dense infiltration and traction bronchiectasis in the bilateral lower lobes.

Fig. 4

Pathologic findings of the lungs and trachea on autopsy in a Japanese man who died from COVID-19. (A) Gross findings show congested lungs and marked emphysematous changes mainly in the upper lung lobes. Microscopic lung findings show (B) organization in the left upper lobe, (C) accumulation of neutrophils in an organized air cavity in the right lower lobe, (D) neutrophilic infiltration in the tracheal mucosa, and (E) thrombus in a pulmonary vessel. (Hematoxylin and eosin stain; B, D, and E × 200; C × 40).