COVID-19 in tobacco users.

Smoking is a significant social problem threatening the population's health, especially during the coronavirus pandemic. Due to the problem's urgency, we present a clinical case of SARS-CoV-2 infection in a patient with 10 years of smoking and concomitant chronic obstructive pulmonary disease (chronic bronchitis and peribronchial pneumosclerosis). Patient L.K., 42 years old, on 13.10.2022, was hospitalized for several hours at the Emergency Hospital of the Ministry of Health of Chuvashia (Cheboksary) with a severe new coronavirus infection. Secondary diagnosis: Chronic obstructive pulmonary disease Case history: for about two to three weeks, the patient noted an increase in body temperature to 37.2-37.4 degreeC and a cough. He has smoked for about 10 years, 1 pack per day. Computed tomography showed signs of bilateral COVID-associated pneumonitis, alveolitis with 85% involvement and consolidation sites, signs of chronic bronchitis, and peribronchial pneumosclerosis. The diagnosis of COVID-19 was confirmed by a polymerase chain reaction in a nasopharyngeal smear. The NEWS2 score was 9. After the treatment started, the patient died. Histological examination showed perivascular sclerosis, peribronchial pneumosclerosis, atrophic changes in the ciliated epithelium, and structural and functional alteration of the bronchial mucosa. In addition, areas of hemorrhage and inflammatory infiltrate in the bronchial wall were found. Coronavirus is known not to cause bronchitis but bronchiolitis. In the presented case, the patient showed signs of transition of bronchitis to the acute stage. Therefore, it can be assumed that the coronavirus acts as a complicating factor. In addition to the described changes, signs of viral interstitial pneumonia, pulmonary edema, and early development of acute respiratory distress syndrome were identified.Copyright © 2023, Media Sphera Publishing Group. All rights reserved.

Acute myocardial infarction and coronavirus infection (COVID-19).

The aim of the study is to describe a case of COVID-19 and myocardial infarction in an elderly patient. Material and methods. The analysis of medical documentation (outpatient card of the patient, medical history, postmortem report) was carried out. Studied macro- and micropreparations (staining with hematoxylin and eosin). Results. A 67-year-old patient, from 23.04.2020 to 26.04.2020, was hospitalized with a diagnosis of suspected coronavirus infection (COVID-19). On the background of the treatment, the patient's biological death occurred (26.04.2020). The sectional study revealed signs of bilateral total hemorrhagic pneumonia. The signs of acute transmural myocardial infarction of the anterior wall of the left ventricle were determined. Posthumously, SARS-CoV-2 RNA was detected in the lung tissue by nucleic acid amplification. In the described clinical case, a patient with concomitant cardiovascular diseases, such as arterial hypertension, coronary heart disease, developed complications against the background of COVID-19: hemorrhagic pneumonia and myocardial infarction with a fatal outcome.Copyright © Infectious Diseases: News, Opinions, Training.

COVID-19 in tobacco users.

Smoking is a significant social problem threatening the population's health, especially during the coronavirus pandemic. Due to the problem's urgency, we present a clinical case of SARS-CoV-2 infection in a patient with 10 years of smoking and concomitant chronic obstructive pulmonary disease (chronic bronchitis and peribronchial pneumosclerosis). Patient L.K., 42 years old, on 13.10.2022, was hospitalized for several hours at the Emergency Hospital of the Ministry of Health of Chuvashia (Cheboksary) with a severe new coronavirus infection. Secondary diagnosis: Chronic obstructive pulmonary disease Case history: for about two to three weeks, the patient noted an increase in body temperature to 37.2-37.4 degreeC and a cough. He has smoked for about 10 years, 1 pack per day. Computed tomography showed signs of bilateral COVID-associated pneumonitis, alveolitis with 85% involvement and consolidation sites, signs of chronic bronchitis, and peribronchial pneumosclerosis. The diagnosis of COVID-19 was confirmed by a polymerase chain reaction in a nasopharyngeal smear. The NEWS2 score was 9. After the treatment started, the patient died. Histological examination showed perivascular sclerosis, peribronchial pneumosclerosis, atrophic changes in the ciliated epithelium, and structural and functional alteration of the bronchial mucosa. In addition, areas of hemorrhage and inflammatory infiltrate in the bronchial wall were found. Coronavirus is known not to cause bronchitis but bronchiolitis. In the presented case, the patient showed signs of transition of bronchitis to the acute stage. Therefore, it can be assumed that the coronavirus acts as a complicating factor. In addition to the described changes, signs of viral interstitial pneumonia, pulmonary edema, and early development of acute respiratory distress syndrome were identified.Copyright © 2023, Media Sphera Publishing Group. All rights reserved.

A CLINICAL CASE OF SARS-CoV-2 INFECTION COMPLICATED BY NEPHROGENIC PULMONARY EDEMA AND COVID-ASSOCIATED PNEUMONITIS, ALVEOLITIS.

COVID-19 is a highly transmissible disease with severe course especially in patients with nephrogenic hypertensive disease and chronic kidney disease due to a higher incidence of all-type infections than in the general population. The aim of the study is to describe a clinical case of SARS-CoV-2 infection complicated by nephrogenic pulmonary edema and COVID-associated pneumonitis, alveolitis. Description of the case. Patient K.S., born in 1975, was hospitalized 24 hours after symptom onset at emergency hospital due to complaints of increased blood pressure up to 180-200/110-120 mm Hg, temperature up to 38.7degreeC, dry cough, feeling of heaviness in the chest, change in urine color. PCR smear for SARS-CoV-2 was positive. Computed tomography revealed a pattern of bilateral COVID-associated pneumonitis, alveolitis, with 75% involvement. The electrocardiogram revealed signs of left ventricular myocardial hypertrophy. Ultrasound examination showed numerous cysts in the kidneys. Urinalysis at admission: leukocytes - 499, erythrocytes - 386. Glomerular filtration rate (CKD-EPI: 29 ml/min/1.73 m2) and corresponds to stage IV of chronic kidney disease. Coagulogram: fibrinogen: 32.3 (1.6-4.0) g/l, D-dimer: 663 (0-250). Despite the treatment, the patient's condition worsened, the phenomena of cardiopulmonary and renal insufficiency increased, which led to a fatal outcome. During a virological study of sectional material: SARS-CoV-2 coronavirus RNA was found in the lung and kidneys. Signs of bilateral COVID-associated pneumonitis, alveolitis with diffuse cellular infiltrates in combination with changes in the alveolar apparatus, signs of pulmonary edema were revealed. Heart-related signs - swelling of the interstitium, fragmented muscle fibers, some of them hypertrophied, a wave-like deformation of cardiomyocytes, blurring of the transverse striation. Arteries with thickened sclerosed walls. In the kidneys - diffuse damage to the proximal tubules of the nephron with areas of cortical and proximal necronephrosis, areas of fibrinoid swelling. Conclusion. The cause of death of a 45-year-old patient was a severe course of bilateral COVID-associated pneumonitis, alveolitis, which contributed to the development of renal medullary hypoxia and type 1 cardiorenal syndrome, which led to early nephrogenic pulmonary edema.Copyright © 2023 Saint Petersburg Pasteur Institute. All rights reserved.

A Case of Abscessed Pneumonia Due to Covid-19 Infection in a Young Patient

Viral infections are the first ranked conditions among infectious diseases causing 5-15% of all community-acquired pneumonia. The aim of the study was to describe a case of COVID-19 infection, proceeding with acquired bacterial infection and developing abscess pneumonia in a young patient. Material and methods. The accompanying medical documentation was examined, clinical and morphological analysis was carried out for assessing macro- and micropreparations. Results. Patient A.E., 31 years old, within 5 hours 10 minutes was at in-hospital treatment with a diagnosis of Coronavirus infection, severe course. Community-acquired bilateral polysegmental pneumonia. The patient admitted with complaints of respiratory difficulty, shortness of breath, weakness, fever up to febrile level, severe pain in the right groin area, both lower extremities, swelling in hands and feet. However, despite initiated treatment, the patient's condition worsened and biological death was verified. The postmortem examination revealed signs of total bilateral hemorrhagic pneumonia. Histological examination showed areas of necrosis in the alveolar epithelium and signs of marked edema with a hemorrhagic component;hemolyzed erythrocytes were found in alveolar lumen. Focal hemorrhages were visualized in the pulmonary parenchyma, sometimes merging along with lung tissue with forming microabscesses. a well-defined shaft consisting of granular leukocytes and congested vessels with erythrocyte sludge was noted on the periphery of necrosis area. In the alveoli located closer to the abscesses, fibrinous and serous exudate was detected. Signs of edema were observed in the brain;histological examination revealed perivascular, pericellular optical voids with vascular congestion, erythrocyte sludge and minor hemorrhages. SARS-CoV-2- caused pneumonia and acquired bacterial infection, in this case due to staphylococcus, led to abscess pneumonia and severe respiratory failure with developing acute distress syndrome. Obviously, the high frequency of destructive processes in staphylococcal pneumonia is due to the pathogenic staphylococci characterized by production of high-level proteolytic enzymes destroying body tissues. Thus, the current case of COVID-19 infection in a young patient is of particular importance and relevance, because it demonstrates an unfavorable disease outcome despite patient young age and lack of concomitant pathology.

Clinical case of SARS-CoV-2 infection in a patient with rheumatoid arthritis and secondary AA-amyloidosis of the lungs

In rheumatic diseases, the risk of infections development is higher than in the general population. The article describes a case of SARS-CoV-2 infection in a patient with rheumatoid arthritis (RA) and secondary AA-amyloidosis of the lungs, which led to a fatal outcome. In the context of the COVID-19 pandemic, RA patients with secondary AA-amyloidosis and pulmonary fibrosis are likely to represent a special risk group for developing a severe course of this infection with a fatal outcome. © 2023, Ima-Press Publishing House. All rights reserved.

PATHOMORPHOLOGICAL FEATURES OF ACUTE RESPIRATORY DISTRESS SYNDROME IN COMPETING LUNG DISEASES: COVID-19 AND SARCOIDOSIS

The COVID-19 pandemic is a worldwide problem. The clinical spectrum of SARS-CoV-2 infection varies from asymptomatic or paucity-symptomatic forms to conditions such as pneumonia, acute respiratory distress syndrome and multiple organ failure. Objective was to describe a clinical case of SARS-CoV-2 infection in the patient with sarcoidosis and cardiovascular pathology developing acute respiratory syndrome and lung edema. Material and methods. There were analyzed accompanying medical documentation (outpatient chart, medical history), clinical and morphological histology data (description of macro- and micro-preparations) using hematoxylin and eosin staining. Results. Lung histological examination revealed signs of diffuse alveolar damage such as hyaline membranes lining and following the contours of the alveolar walls. Areas of necrosis and desquamation of the alveolar epithelium in the form of scattered cells or layers, areas of hemorrhages and hemosiderophages are detected in the alveolar walls. In the lumen of the alveoli, a sloughed epithelium with a hemorrhagic component, few multinucleated cells, macrophages, protein masses, and accumulated edematous fluid were determined. Pulmonary vessels are moderately full-blooded, surrounded by perivascular infiltrates. Signs of lung sarcoidosis were revealed. Histological examination found epithelioid cell granulomas consisting of mononuclear phagocytes and lymphocytes, without signs of necrosis. Granulomas with a proliferative component and hemorrhage sites were determined. Giant cells with cytoplasmic inclusions were detected — asteroid corpuscles and Schauman corpuscles. Non-caseous granulomas consisting of clusters of epithelioid histiocytes and giant Langhans cells surrounded by lymphocytes were detected in the lymph nodes of the lung roots. Hamazaki–Wesenberg corpuscles inside giant cells were found in the zones of peripheral sinuses of lymph nodes. In the lumen of the bronchi, there was found fully exfoliated epithelium, mucus. Granulomas are mainly observed subendothelially on the mucous membrane, without caseous necrosis. Histological examination of the cardiovascular system revealed fragmentation of some cardiomyocytes, cardiomyocyte focal hypertrophy along with moderate interstitial edema, erythrocyte sludge. Zones of small focal sclerosis were determined. The vessels of the microcirculatory bed are anemic, with hypertrophy of the walls in small arteries and arterioles. Virological examination of the sectional material in the lungs revealed SARS-CoV-2 RNA. Conclusion. Based on the data of medical documentation and the results of a post-mortem examination, it follows that the cause of death of the patient R.A., 50 years old, was a new coronavirus infection COVID-19 that resulted in bilateral total viral pneumonia. Сo-morbidity with competing diseases such as lung sarcoidosis and cardiovascular diseases aggravated the disease course, led to the development of early ARDS and affected the lethal outcome. © 2022 Saint Petersburg Pasteur Institute. All rights reserved.

A clinical case of SARS-CoV-2 infection complicated by acute respiratory distress syndrome, pulmonary edema, and heart failure in the presence of chronic venous congestion in a patient with chronic rheumatic heart disease

The article presents a clinical case of SARS-CoV-2 infection complicated by acute respiratory distress syndrome, pulmonary edema, and heart failure in the presence of chronic venous congestion in a patient with chronic rheumatic heart disease. A female patient R., 65 years old, was hospitalized at the Republican Cardiological Dispensary with a diagnosis of novel coronavirus infection COVID-19 (severe course);the virus was identified. Competing diagnosis: (1) acute viral myocarditis;(2) chronic rheumatic heart disease with combined mitral-aortic disease. Complications of the underlying disease included viral interstitial pneumonia (75%) and pulmonary edema. The patient was admitted at day 8 from the onset of the disease with complaints of increase in body temperature up to 38.5 °C, chest pain, and shortness of breath. She was treated in the outpatient setting without visible improvement. The patient had a history of chronic rheumatic heart disease. Due to persistent fever, patient received computed tomography showing interstitial pneumonia of viral etiology. The diagnosis of COVID-19 was based on a typical clinical presentation and a positive PCR test in nasopharyngeal swabs. Nonspecific changes were observed in the electrocardiogram. Treatment was initiated without positive dynamics, and a fatal outcome occurred. According to the autopsy data, the organs showed signs of chronic venous congestion (brown induration of the lungs, nutmeg fibrosis, cyanotic induration of the spleen and kidneys). The infiltrates consisting of lymphocytes and eosinophils were detected in the myocardium. Also, edema of the intercellular space, plethora of microvasculature vessels, and dystrophic changes in cardiomyocytes were detected. The presence of Aschoff-Talalaev granulomas with fibrinoid necrosis and avulsion of the chorda of the mitral valve leaflet was observed. Morphologically, there were signs of pulmonary infarction with a polysegmental character. Thus, in the presented case, the scientific novelty was the extremely rare development of mitral valve chord avulsion in aortic-mitral disease after infection with SARS-CoV-2, which was the cause of acute heart failure. It is likely that the process was aggravated by concomitant diffuse interstitial serous myocarditis and fibrinoid necrosis in granulomas. © 2022 by the Author(s).

PATHOMORPHOLOGICAL FEATURES OF ACUTE RESPIRATORY DISTRESS SYNDROME IN COMPETING LUNG DISEASES: COVID-19 AND SARCOIDOSIS

The COVID-19 pandemic is a worldwide problem. The clinical spectrum of SARS-CoV-2 infection varies from asymptomatic or paucity-symptomatic forms to conditions such as pneumonia, acute respiratory distress syndrome and multiple organ failure. Objective was to describe a clinical case of SARS-CoV-2 infection in the patient with sarcoidosis and cardiovascular pathology developing acute respiratory syndrome and lung edema. Material and methods. There were analyzed accompanying medical documentation (outpatient chart, medical history), clinical and morphological histology data (description of macro- and micro-preparations) using hematoxylin and eosin staining. Results. Lung histological examination revealed signs of diffuse alveolar damage such as hyaline membranes lining and following the contours of the alveolar walls. Areas of necrosis and desquamation of the alveolar epithelium in the form of scattered cells or layers, areas of hemorrhages and hemosiderophages are detected in the alveolar walls. In the lumen of the alveoli, a sloughed epithelium with a hemorrhagic component, few multinucleated cells, macrophages, protein masses, and accumulated edematous fluid were determined. Pulmonary vessels are moderately full-blooded, surrounded by perivascular infiltrates. Signs of lung sarcoidosis were revealed. Histological examination found epithelioid cell granulomas consisting of mononuclear phagocytes and lymphocytes, without signs of necrosis. Granulomas with a proliferative component and hemorrhage sites were determined. Giant cells with cytoplasmic inclusions were detected — asteroid corpuscles and Schauman corpuscles. Non-caseous granulomas consisting of clusters of epithelioid histiocytes and giant Langhans cells surrounded by lymphocytes were detected in the lymph nodes of the lung roots. Hamazaki–Wesenberg corpuscles inside giant cells were found in the zones of peripheral sinuses of lymph nodes. In the lumen of the bronchi, there was found fully exfoliated epithelium, mucus. Granulomas are mainly observed subendothelially on the mucous membrane, without caseous necrosis. Histological examination of the cardiovascular system revealed fragmentation of some cardiomyocytes, cardiomyocyte focal hypertrophy along with moderate interstitial edema, erythrocyte sludge. Zones of small focal sclerosis were determined. The vessels of the microcirculatory bed are anemic, with hypertrophy of the walls in small arteries and arterioles. Virological examination of the sectional material in the lungs revealed SARS-CoV-2 RNA. Conclusion. Based on the data of medical documentation and the results of a post-mortem examination, it follows that the cause of death of the patient R.A., 50 years old, was a new coronavirus infection COVID-19 that resulted in bilateral total viral pneumonia. Сo-morbidity with competing diseases such as lung sarcoidosis and cardiovascular diseases aggravated the disease course, led to the development of early ARDS and affected the lethal outcome.

PATHOMORPHOLOGICAL FEATURES OF ACUTE RESPIRATORY DISTRESS SYNDROME IN COMPETING LUNG DISEASES: COVID-19 AND SARCOIDOSIS.

The COVID-19 pandemic is a worldwide problem. The clinical spectrum of SARS-CoV-2 infection varies from asymptomatic or paucity-symptomatic forms to conditions such as pneumonia, acute respiratory distress syndrome and multiple organ failure. Objective was to describe a clinical case of SARS-CoV-2 infection in the patient with sarcoidosis and cardiovascular pathology developing acute respiratory syndrome and lung edema. Material and methods. There were analyzed accompanying medical documentation (outpatient chart, medical history), clinical and morphological histology data (description of macro- and micro-preparations) using hematoxylin and eosin staining. Results. Lung histological examination revealed signs of diffuse alveolar damage such as hyaline membranes lining and following the contours of the alveolar walls. Areas of necrosis and desquamation of the alveolar epithelium in the form of scattered cells or layers, areas of hemorrhages and hemosiderophages are detected in the alveolar walls. In the lumen of the alveoli, a sloughed epithelium with a hemorrhagic component, few multinucleated cells, macrophages, protein masses, and accumulated edematous fluid were determined. Pulmonary vessels are moderately full-blooded, surrounded by perivascular infiltrates. Signs of lung sarcoidosis were revealed. Histological examination found epithelioid cell granulomas consisting of mononuclear phagocytes and lymphocytes, without signs of necrosis. Granulomas with a proliferative component and hemorrhage sites were determined. Giant cells with cytoplasmic inclusions were detected - asteroid corpuscles and Schauman corpuscles. Non-caseous granulomas consisting of clusters of epithelioid histiocytes and giant Langhans cells surrounded by lymphocytes were detected in the lymph nodes of the lung roots. Hamazaki-Wesenberg corpuscles inside giant cells were found in the zones of peripheral sinuses of lymph nodes. In the lumen of the bronchi, there was found fully exfoliated epithelium, mucus. Granulomas are mainly observed subendothelially on the mucous membrane, without caseous necrosis. Histological examination of the cardiovascular system revealed fragmentation of some cardiomyocytes, cardiomyocyte focal hypertrophy along with moderate interstitial edema, erythrocyte sludge. Zones of small focal sclerosis were determined. The vessels of the microcirculatory bed are anemic, with hypertrophy of the walls in small arteries and arterioles. Virological examination of the sectional material in the lungs revealed SARS-CoV-2 RNA. Conclusion. Based on the data of medical documentation and the results of a post-mortem examination, it follows that the cause of death of the patient R.A., 50 years old, was a new coronavirus infection COVID-19 that resulted in bilateral total viral pneumonia. So-morbidity with competing diseases such as lung sarcoidosis and cardiovascular diseases aggravated the disease course, led to the development of early ARDS and affected the lethal outcome. Copyright © 2022 Saint Petersburg Pasteur Institute. All rights reserved.

Pathological changes in organs in rheumatoid arthritis with secondary amyloidosis of the heart and kidneys on the background of COVID-19

The COVID-19 pandemic is a global health emergency. The relevance of this problem in immunoinflammatory rheumatic diseases is due to the increased risk of infection with SARS-CoV-2 and its severe course. The paper describes the clinical features and morphological changes in organs in a patient with rheumatoid arthritis and secondary amyloidosis of the heart and kidneys, who died from an infection caused by SARS-CoV-2. © 2022, Ima-Press Publishing House. All rights reserved.

[A rare case of multifocal leukoencephalopathy and cerebral stroke after SARS-CoV-2 infection]. / Mul'tifokal'naya leikoentsefalopatiya i ostryi insul't posle infitsirovaniya virusom SARS-CoV-2.

A case of the development of multifocal leukoencephalopathy and hemorrhage after infection with SARS-CoV-2 in a female patient with Alzheimer's disease, aged 67 years, is described. The patient was hospitalized by an ambulance. Computed tomography (CT) of the brain showed the signs of cerebral infarction in the basin of the left middle cerebral artery with hemorrhagic transformation, multiple low-density foci that do not accumulate contrast in the white matter of the brain, the presence of sickle-shaped lesions in the cerebellum. CT of the chest revealed bilateral diffuse COVID-associated pneumonitis, alveolitis. The percentage of lesion was 75%. A smear express test for a new coronavirus infection was positive. Treatment was started, and a sudden death occurred. A sectional study in the brain revealed signs of ischemic cerebral infarction and multifocal leukoencephalomalacia - foci of demyelination (from 1 mm to 1 cm) had a multifocal lesion located in different parts of the white matter. Fibrinoid necrosis of vessel walls, destructive-productive vasculitis, ischemic small-focal perivascular necrosis, ischemic lesions of neurons and glial cells, neuronal and glial spongiosis were noted. In conclusion, the cause of death of the patient was a new coronavirus infection COVID-19, which caused diffuse viral COVID-associated pneumonitis, alveolitis with the development of acute respiratory distress syndrome in adults, respiratory failure and COVID-associated ischemic infarction, multifocal leukoencephalopathy (or malacia), cerebral edema complicated by neuromorphological changes in the brain.

[The case of the development of ischemic stroke and cerebral edema after SARS-COV-2 infection in a patient with discirculatory encephalopathy and concomitant schizophrenia]. / Sluchai razvitiya ishemicheskogo insul'ta i oteka golovnogo mozga posle infitsirovaniya SARS-CoV-2 na fone distsirkulyatornoi entsefalopatii i soputstvuyushchei shizofrenii.

The article presents a case of ischemic stroke after SARS-CoV-2 infection in a patient with dyscirculatory encephalopathy and schizophrenia. Patient 44 years old, was hospitalized due to a confirmed diagnosis of a new coronavirus infection (COVID-19) and diagnosed bilateral pneumonia with a damage to 65% of the lung parenchyma. The patient has a history of dyscirculatory encephalopathy and paranoid schizophrenia, a continuous type of course. A fatal outcome occurs on the 2nd day of inpatient treatment. A brain autopsy revealed pericellular and perivascular edema, looseness of neuroglia with necrobiotic changes in the brain substance. Neuronal damage, small-focal gliosis, basophilic balls, destructive-productive vasculitis, ischemic small-focus necrosis were revealed. In the lungs, areas of atelectasis, disatelectasis, hyaline membranes, and edematous fluid were found. Epithelium of the convoluted tubules showed dystrophic and necrotic changes. The cause of death of the patient was a new coronavirus infection COVID-19, which caused bilateral viral pneumonia, complicated by the development of acute respiratory failure and COVID-associated ischemic cerebral infarction complicated by neuromorphological changes in the brain.

Organ changes after SARS-CoV-2 infection in a patient with systemic sclerosis according to autopsy

The article presents a description of a clinical case with a fatal outcome due to SARS-CoV-2 coronavirus-induced bilateral viral pneumonia with areas of pneumofibrosis, complicated by acute respiratory failure. The presence of systemic sclerosis in this patient aggravated the course of the disease and became one of the causes of death. Autopsy revealed signs of bilateral pneumonia with lesions in both lungs and areas of pneumofibrosis. Histological examination revealed alveoli with rupture of interalveolar septa, areas of atelectasis, serous-purulent exudate with desquamated alveolocytes, places with organization of exudate, zones of pneumofibrosis. Scleroderma cardiosclerosis, linear necrosis of cardiomyocytes were present in the heart. There were signs of multiple organ failure — pulmonary edema, cerebral edema. © 2022, Ima-Press Publishing House. All rights reserved.

Ischemic cerebral stroke and acute heart failure after re-infection with SARS-CoV-2 against the background of diabetes mellitus

Diabetes mellitus in COVID-19 is recognized as one of the important risk factors for the development of unfavorable outcomes due to a more severe course of infection in conditions of hyperglycemia and aggravating conditions (old age, cardiovascular diseases). Purpose of the study. Description of a clinical case of the development of ischemic cerebral stroke and acute heart failure after repeated infection with SARS-CoV-2 against the background of diabetes mellitus. Material and methods. The analysis of the accompanying medical documentation received (outpatient card of the patient, medical history) was carried out. A standard autopsy technique was used. To process histological sections of autopsy material, hematoxylin and eosin staining was used. Results. In the pulmonary parenchyma, not only signs of a phase of diffuse alveolar damage were revealed, but also areas of fibrosis;however, against the background of repeated infection, there were no hyaline membranes along the contour of the alveoli. There was no clear gradation of these phases, there was a blurring of the classical picture. In the vessels immediately adjacent to the sites of ischemic stroke, there was no connection between the thrombus and the atherosclerotic plaque, and there were no signs of inflammation of the vascular wall. In the heart, areas of homogenization of muscle fibers with loss of nuclei and transverse striation, with minor hemorrhages and poorly expressed perifocal neutrophilic infiltration, pronounced interstitial edema, foci of uneven myocardial blood filling in the interventricular septum were identified. The contractile cardiomyocytes showed signs of hydropic dystrophy. Conclusion. In a patient with type 2 diabetes mellitus with an increased glycemic status, reinfected with SARS-CoV-2, an unfavorable outcome is due to the development of COVID-associated myocardial infarction, multifocal ischemic cerebral infarction and acute renal injury (necronephrosis). © 2022, Media Sphera Publishing Group. All rights reserved.

Changes in organs after coronavirus infection covid-19: A clinical case

The SARS-CoV-2 virus has caused one of the most massive pandemics in modern history. The article describes a clinical case of death of a patient who had previously undergone COVID-19. An analysis of the accompanying medical documentation received (patient’s outpatient card, medical history), clinical and morphological analysis (description of macro- and micro-preparations) were carried out using histological and immune-histochemical research methods. Based on the data of medical documentation and the results of postmortem examination it was concluded that the cause of the patient’s death was bilateral organizing pneumonia as a result of pneumonia in combination with ischemic cerebral infarction, complicated by multiple organ failure. © 2021, Media Sphera Publishing Group. All rights reserved.

Acute myocardial infarction and coronavirus infection (COVID-19)

The aim of the study is to describe a case of COVID-19 and myocardial infarction in an elderly patient. Material and methods. The analysis of medical documentation (outpatient card of the patient, medical history, postmortem report) was carried out. Studied macro- and micropreparations (staining with hematoxylin and eosin). Results. A 67-year-old patient, from 23.04.2020 to 26.04.2020, was hospitalized with a diagnosis of suspected coronavirus infection (COVID-19). On the background of the treatment, the patient's biological death occurred (26.04.2020). The sectional study revealed signs of bilateral total hemorrhagic pneumonia. The signs of acute transmural myocardial infarction of the anterior wall of the left ventricle were determined. Posthumously, SARS-CoV-2 RNA was detected in the lung tissue by nucleic acid amplification. In the described clinical case, a patient with concomitant cardiovascular diseases, such as arterial hypertension, coronary heart disease, developed complications against the background of COVID-19: hemorrhagic pneumonia and myocardial infarction with a fatal outcome. © Infectious Diseases: News, Opinions, Training.

Changes in the brain, lungs and heart with covid-19 against the background of cerebrovascular pathology

The global spread of COVID-19 has become a major health problem in the world. The elderly population with hypertension, car-diovascular and cerebrovascular diseases are at risk for COVID-19 infection. Objective. To describe changes in the brain, lungs and heart in COVID-19 against the background of cerebrovascular pathology in an elderly patient. Material and methods. Patient B., 65 years old, was hospitalized in the intensive care unit with a diagnosis of severe COVID-19. Chronic cerebral circulation insufficiency. He was admitted accompanied by an ambulance team with complaints to fever up to 38.3 °C, cough, weakness. From the anamnesis it is known that outpatient treatment with antibacterial drugs was carried out without positive dynamics. In this regard, he was hospitalized for inpatient treatment. Results. Against the background of the ongoing treatment, the patient worsened, and biological death occurred. Pathological and anatomical examination revealed the signs of chronic cerebral ischemia. During histological examination, pronounced dys-trophic, atrophic changes of neurons with loosened neuroglia, perivascular and pericellular edema, areas of erythrocytic slides were observed. In parieto-occipital area of the brain — atrophic, cystic-gliose changes. In cerebral vessels — atherosclerotic plaques, in the stage of atheromatosis and atherocalcinosis, stenosing the lumen up to 60—80%. There were signs of bilateral pol-ysegmental viral pneumonia, with predominant involvement of lower lung lobes. Macroscopic examination of the heart revealed postinfarction cardiosclerosis with erythrocyte sludge. Conclusion. The presence of concomitant pathology weighs down the course of COVID-19 and leads to cerebral edema and acute lung and heart failure. © 2020, Media Sphera Publishing Group. All rights reserved.

Organ-specific pathomorphological changes during COVID-19

COVID-19 is an acute respiratory infection caused by SARS-CoV-2 coronavirus causing pneumonia, lesions in the cardiovascular system and other organs, high mortality risk, especially in geriatric patients. Due to the great relevance, this study was aimed at describing the case of severe COVID-19 with development of multiple organ failure. Materials and methods. Available accompanying medical documentation (outpatient charts, medical history) was analyzed. Clinical and morphological analysis was carried out by providing description of macro- and micropreparations;histological methods (hematoxylin and eosin staining, Lee reaction) were used. Results. Female patient K.G., 69 years old, was hospitalized to the therapeutic department diagnosed with coronary heart disease. Acute coronary syndrome with ST segment elevation was made on 04/20/2020. A competing diagnosis: severe community-acquired bilateral multi-segmental pneumonia. The patient's condition was aggravated wile applying therapy followed by biological death occurred. An autopsy revealed bilateral subtotal hemorrhagic pneumonia. Macroscopic lung examination demonstrated "lungs filled with red fluid". In the brain - perivascular and pericellular edema, hyalinosis, blood stasis and sludge, marked dystrophic and necrotic neuronal changes. Cardiomyocyte fragmentation, areas of perivascular sclerosis with inflammatory infiltrates as well as erythrocytic sludge are found in the heart and blood vessels, respectively. A weak positive reaction according to Lee method was observed. Such clinical and morphological case demonstrates along with lung damage involvement of the heart resulting in acute coronary syndrome (morphologically manifested by ischemic myocardial dystrophy) and the brain. Thus, premorbid background in elderly patients results in developing acute pulmonary heart failure, pulmonary and cerebral edema.