Autopsy findings of a patient with severe COVID-19 treated with long-term extracorporeal membrane oxygenation

Keigo Sekihara; Tatsuki Uemura; Tatsuya Okamoto; Mayu Sugiyama; Kaoru Yoshikawa; Koichiro Tomiyama; Takatoshi Shibasaki; Fumito Kato; Hideki Miyazaki; Toru Igari; Akio Kimura

doi:10.1016/j.rmcr.2022.101595

Autopsy findings of a patient with severe COVID-19 treated with long-term extracorporeal membrane oxygenation

Respir Med Case Rep. 2022:36:101595. doi: 10.1016/j.rmcr.2022.101595. Epub 2022 Jan 29.

Authors

Keigo Sekihara¹, Tatsuki Uemura^{1

2}, Tatsuya Okamoto¹, Mayu Sugiyama¹, Kaoru Yoshikawa¹, Koichiro Tomiyama^{1

2}, Takatoshi Shibasaki^{1

2}, Fumito Kato^{1

2}, Hideki Miyazaki³, Toru Igari³, Akio Kimura^{1

2}

Affiliations

¹ Department of Intensive Care Medicine, Center Hospital of the National Center for Global Health and Medicine, Shinjuku, Tokyo, Japan.
² Department of Emergency Medicine and Critical Care, Center Hospital of the National Center for Global Health and Medicine, Shinjuku, Tokyo, Japan.
³ Pathology Division of Clinical Laboratory, Center Hospital of the National Center for Global Health and Medicine, Shinjuku, Tokyo, Japan.

Abstract

Extracorporeal membrane oxygenation (ECMO) therapy in patients with coronavirus disease 2019 (COVID-19) has a low frequency of use, and thus pathological findings in such patients are valuable. In this case report, a 62-year-old man with a history of hypertension presented with a runny nose. After an at-home COVID-19 positive test, he developed dyspnea and fever. Once admitted to our hospital, his oxygenation worsened, and ECMO was initiated. He died from respiratory failure 69 days after ECMO induction. Macroscopically, the lungs gained mass, were partially consolidated, and were airless. Histological analysis revealed diffuse bronchial epithelial metaplasia and adenoid metaplasia in the alveolar epithelium. Although the lung parenchyma was partially preserved, there was organizing and fibrosis that filled pulmonary alveolus due to COVID-19 and changes resulting from disuse and long-term ECMO.

Keywords: Autopsy pathology; COVID-19; Diffuse alveolar damage; Extracorporeal membrane oxygenation; Pulmonary hemorrhage; SARS-CoV-2.

Publication types

Case Reports