ABSTRACT
The autopsy findings for 3 cases of SARS-(CoV-2) pneumonia-related deaths are reported with pulmonary histology and immunohistochemistry findings. In 2 cases (cases 1 and 2), the time interval from presentation to death was approximately 1 week, whereas for case 3, the time interval from presentation to death was hours. Case 1 and case 2 presented with shortness of breath, cough, and flu-like symptoms. The decedent from case 3 died shortly after presenting to a local emergency room with high fever, chest and abdominal pain, and shortness of breath. All 3 cases had 1 or more comorbidities. The postmortem interval for cases 1 and 2 was 2 weeks as they died at sea and were stored on board within the respective cruise ships' refrigeration units, whereas case 3 was examined within 24 hours of death. The autopsies were conducted at the Miami-Dade County Medical Examiners Department under routine infectious precautions. Salient clinical history and autopsy findings are summarized. Microscopic examination revealed pneumonia with associated atypical endovascular cells.
Subject(s)
Betacoronavirus , Coronavirus Infections/pathology , Pneumonia, Viral/pathology , Adult , Autopsy , COVID-19 , Cardiomegaly/complications , Cardiomegaly/pathology , Circle of Willis/pathology , Comorbidity , Coronary Artery Disease/complications , Coronary Artery Disease/pathology , Coronavirus Infections/complications , Diabetes Complications/pathology , Fatal Outcome , Female , Humans , Hyperlipidemias/complications , Hyperlipidemias/pathology , Lung/pathology , Male , Middle Aged , Nasopharynx/virology , Obesity/complications , Obesity/pathology , Pandemics , Pneumonia, Viral/complications , Pulmonary Edema/complications , Pulmonary Edema/pathology , SARS-CoV-2 , Tobacco Use/pathologyABSTRACT
The initial cases of novel coronavirus disease-19 (COVID-19) in a country are of utmost importance given their impact on healthcare providers, the country's preparedness response, and the initial molding of the public perception toward this pandemic. In Bhutan, the index case was a 76-year-old immunocompromised man who had traveled from the United States and entered Bhutan as a tourist. He presented initially with vague gastrointerestinal symptoms and later a cough. His atypical presentation led to a delay in diagnosis, but ultimately he was isolated and tested. On confirming the diagnosis of COVID-19, the patient was isolated in a separate hospital with a dedicated medical care team. All contacts were traced and quarantined. The patient's respiratory status deteriorated despite broad-spectrum antivirals, antibiotics, and intensive supportive care. He required intubation and was given a trial of intravenous immunoglobulin to modulate his likely aberrant immune response. Subsequently, the patient's clinical status improved, and after 8 days of hospitalization, he was transferred out of the country, where he recovered. This was a learning experience for the treating medical staff, the government, and the people of Bhutan.