Evolution of severe acute respiratory syndrome coronavirus 2 RNA test results in a patient with fatal coronavirus disease 2019: a case report

• Published in: Human pathology Vol. 101; pp. 82 - 88
• Main Authors: Shao, Chen, Liu, Hui, Meng, Lingjia, Sun, Lin, Wang, Yankun, Yue, Zhujun, Kong, Heli, Li, Hongjun, Weng, Honglei, Lv, Fudong, Jin, Ronghua
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2020; Elsevier Limited; The Author(s). Published by Elsevier Inc
• Subjects: Acidosis; Aged; Antibiotics; Bacterial infections; Betacoronavirus - genetics; Biopsy; Biotechnology; Case reports; Clinical Laboratory Techniques; Cloning; Coronavirus; Coronavirus Infections - complications; Coronavirus Infections - diagnosis; Coronavirus Infections - virology; Coronaviruses; COVID-19; COVID-19 Testing; Cytomegalovirus; Disease; Disease Progression; Edema; Fatal Outcome; Humans; Hyperplasia; Infections; Lung - diagnostic imaging; Lung - pathology; Lung - virology; Lungs; Male; Multiorgan failure; Multiple Organ Failure - virology; Neutrophils; Pandemics; Patients; Pneumonia; Pneumonia, Viral - complications; Pneumonia, Viral - diagnosis; Pneumonia, Viral - virology; Predictive Value of Tests; Proteins; Real-Time Polymerase Chain Reaction; Respiratory failure; RNA, Viral - genetics; SARS-CoV-2; Secondary bacterial infection; Sepsis; Severe acute respiratory syndrome coronavirus 2; Test systems; Time Factors; Tomography, X-Ray Computed; Viral Load; Beijing China; China; SARS-CoV-2; Coronavirus; Secondary bacterial infection; Multiorgan failure
• ISSN: 0046-8177; 1532-8392
• DOI: 10.1016/j.humpath.2020.04.015

A 65-year-old man was hospitalized owing to fever (38.6 °C) and dry cough since 4 days. He visited Wuhan 8 days ago. At admission, nasopharyngeal swab samples were taken, and polymerase chain reaction analysis confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA positivity. On day 9, after admission, the chest computed tomography scan showed diffuse ground-glass shadows in the patient's bilateral lungs. On day 11, his respiratory symptoms worsened. Subsequently, type I respiratory failure was diagnosed, coinciding with kidney injury, and subsequently, type II respiratory failure occurred, coupled with multiorgan failure including the heart and liver. However, the patient's constitution worsened although SARS-CoV-2 tests were negative since day 13. He died on day 21. Lung biopsy showed areas of diffuse alveolar damage, characterized by extensive acute alveolitis with numerous intra-alveolar neutrophil, lymphocyte, and macrophage infiltrations. Microthrombi were seen in the dilated pulmonary capillaries. Immunohistochemistry staining for SARS-CoV-2 N protein was negative. Taken together, the patient died of multiorgan failure although the SARS-CoV-2 infection was cleared already, implicating that for disease worsening, no active SARS-CoV-2 infection is required.