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

ABSTRACT

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.