• Myriam Remmelink, Ricardo De Mendonça, Nicky D'Haene, Sarah De Clercq, Camille Verocq, Laetitia Lebrun, Philomène Lavis, Marie-Lucie Racu, Anne-Laure Trépant, Calliope Maris, Sandrine Rorive, Jean-Christophe Goffard, Olivier De Witte, Lorenzo Peluso, Jean-Louis Vincent, Christine Decaestecker, Fabio Silvio Taccone, and Isabelle Salmon.
• Department of Pathology, Erasme Hospital, Université Libre de Bruxelles (ULB), Route de Lennik 808, 1070, Brussels, Belgium.
• Crit Care. 2020 Aug 12; 24 (1): 495495.

BackgroundPost-mortem studies can provide important information for understanding new diseases and small autopsy case series have already reported different findings in COVID-19 patients.MethodsWe evaluated whether some specific post-mortem features are observed in these patients and if these changes are related to the presence of the virus in different organs. Complete macroscopic and microscopic autopsies were performed on different organs in 17 COVID-19 non-survivors. Presence of SARS-CoV-2 was evaluated with immunohistochemistry (IHC) in lung samples and with real-time reverse-transcription polymerase chain reaction (RT-PCR) test in the lung and other organs.ResultsPulmonary findings revealed early-stage diffuse alveolar damage (DAD) in 15 out of 17 patients and microthrombi in small lung arteries in 11 patients. Late-stage DAD, atypical pneumocytes, and/or acute pneumonia were also observed. Four lung infarcts, two acute myocardial infarctions, and one ischemic enteritis were observed. There was no evidence of myocarditis, hepatitis, or encephalitis. Kidney evaluation revealed the presence of hemosiderin in tubules or pigmented casts in most patients. Spongiosis and vascular congestion were the most frequently encountered brain lesions. No specific SARS-CoV-2 lesions were observed in any organ. IHC revealed positive cells with a heterogeneous distribution in the lungs of 11 of the 17 (65%) patients; RT-PCR yielded a wide distribution of SARS-CoV-2 in different tissues, with 8 patients showing viral presence in all tested organs (i.e., lung, heart, spleen, liver, colon, kidney, and brain).ConclusionsIn conclusion, autopsies revealed a great heterogeneity of COVID-19-associated organ injury and the remarkable absence of any specific viral lesions, even when RT-PCR identified the presence of the virus in many organs.

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