Pulmonary Pathology of COVID-19 Following 8 Weeks to 4 Months of Severe Disease: A Report of Three Cases, Including One With Bilateral Lung Transplantation

Author:

Aesif Scott W1,Bribriesco Alejandro C2,Yadav Ruchi3,Nugent Summer L4,Zubkus Dmitriy5,Tan Carmela D1,Mehta Atul C6,Mukhopadhyay Sanjay1ORCID

Affiliation:

1. Department of Pathology, Cleveland, OH

2. Department of Thoracic and Cardiovascular Surgery, Cleveland, OH

3. Imaging Institute, and Cleveland Clinic, Cleveland, OH

4. Department of Pathology Critical Care, WellSpan York Hospital, York, PA

5. Department of Pulmonary and Critical Care, WellSpan York Hospital, York, PA

6. Respiratory Institute, Cleveland Clinic, Cleveland, OH

Abstract

Abstract Objectives Current knowledge of the pulmonary pathology of coronavirus disease 2019 (COVID-19) is based largely on postmortem studies. In most, the interval between disease onset and death is relatively short (<1 month). Information regarding lung pathology in patients who survive for longer periods is scant. We describe the pathology in three patients with severe COVID-19 who underwent antemortem examination of lung tissue at least 8 weeks after initial diagnosis. Methods We conducted a retrospective case series. Results The first patient developed acute respiratory failure and was started on extracorporeal membrane oxygenation (ECMO) on day 21, with subsequent hemothorax. Debridement (day 38) showed extensive lung infarction with diffuse alveolar damage and Candida overgrowth. The second patient developed acute respiratory failure requiring mechanical ventilation that did not improve despite ECMO. Surgical lung biopsy on day 74 showed diffuse interstitial fibrosis with focal microscopic honeycomb change. The third patient also required ECMO and underwent bilateral lung transplantation on day 126. The explanted lungs showed diffuse interstitial fibrosis with focal microscopic honeycomb change. Conclusions This series provides histologic confirmation that complications of COVID-19 after 8 weeks to 4 months of severe disease include lung infarction and diffuse interstitial fibrosis.

Publisher

Oxford University Press (OUP)

Subject

General Medicine

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