ABSTRACT
COVID-19 is characterized by a broad range of symptoms and disease trajectories. Understanding the correlation between clinical biomarkers and lung pathology during acute COVID-19 is necessary to understand its diverse pathogenesis and inform more effective treatments. Here, we present an integrated analysis of longitudinal clinical parameters, peripheral blood markers, and lung pathology in 142 Brazilian patients hospitalized with COVID-19. We identified core clinical and peripheral blood signatures differentiating disease progression between patients who recovered from severe disease compared with those who succumbed to the disease. Signatures were heterogeneous among fatal cases yet clustered into two patient groups: "early death" (<15 days until death) and "late death" (>15 days). Progression to early death was characterized systemically and in lung histopathological samples by rapid endothelial and myeloid activation and the presence of thrombi associated with SARS-CoV-2+ macrophages. In contrast, progression to late death was associated with fibrosis, apoptosis, and SARS-CoV-2+ epithelial cells in postmortem lung tissue. In late death cases, cytotoxicity, interferon, and T helper 17 (TH17) signatures were only detectable in the peripheral blood after 2 weeks of hospitalization. Progression to recovery was associated with higher lymphocyte counts, TH2 responses, and anti-inflammatory-mediated responses. By integrating antemortem longitudinal blood signatures and spatial single-cell lung signatures from postmortem lung samples, we defined clinical parameters that could be used to help predict COVID-19 outcomes.
Subject(s)
COVID-19 , Disease Progression , Lung , SARS-CoV-2 , Humans , COVID-19/blood , COVID-19/diagnosis , Lung/pathology , SARS-CoV-2/isolation & purification , Male , Female , Middle Aged , Biomarkers/blood , Single-Cell Analysis , Adult , Brazil , AgedABSTRACT
Lipoma arborescens is a rare and benign intra-articular lesion of unknown etiology; it is characterized by synovial villous proliferation and sub-synovial connective tissue replacement by mature fatty tissue. It is part of the differential diagnosis in patients with an articulation affected by a slow, progressive, and chronically inflamed affection. We report primary knee involvement in a patient without significant articulate antecedents. Lipoma arborescens was diagnosed after knee magnetic resonance imaging and was confirmed by an anatomopathological study of the surgical specimen.