SARS-CoV-2-related deaths in routine forensic autopsy practice: histopathological patterns
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CASE REPORT
SARS-CoV-2-related deaths in routine forensic autopsy practice: histopathological patterns Antonio Tombolini 1 & Roberto Scendoni 1 Received: 6 May 2020 / Accepted: 18 June 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract “Severe acute respiratory syndrome” (SARS) due to coronavirus (SARS-CoV-2) infection is a well-known cause of death. Sometimes, demise can occur unexpectedly in apparently previous healthy individual after a brief period of trivial flu-like symptoms. In these doubtful cases, the forensic pathologist could be requested to define the cause of death occurred outside the hospital. In this report, the authors describe two autopsied cases of SARS-CoV-2-related deaths which occurred suddenly at home and were not preceded by hospitalization, highlighting associated histopathologic patterns and correlating them to pathophysiology of viral infection. Keywords SARS-CoV-2 . Forensic autopsy . Histopathology
Introduction The recent pandemic outbreak of SARS-CoV-2 (COVID-19) infection constitutes the leading health risk worldwide. In Italy, during the first 4 months of 2020, especially among elderly and/or immunocompromised patients, SARSCoV-2 has been responsible of a peak of morbidity and mortality, still developing today [1]. Furthermore, COVID-19 infection constitutes not only a cause of work overload but also a peculiar health risk for all healthcare staff. On April 2020, the Italian Health Ministry had advised to avoid autopsy in case of comproved COVID-19-related death [2], depriving pathologists of a powerful tool for highlighting pathophysiology of SARS-CoV-2 infection [3]. Nevertheless, the forensic pathologist is not infrequently requested to autoptically define the cause of death occurred at home in doubtful cases, not immediately suspected to be SARS-CoV-2 related [4]. In the present report, the authors briefly describe two autoptic cases of SARS-CoV-2-related deaths. Autopsies were requested by the family physician in order to define the cause of unexpected demise of the two women, preceded only * Antonio Tombolini [email protected] 1
UOC Medicina Legale ASUR AV3, Via Annibali 31L Piediripa, 62100 Macerata, Italy
by a brief period of flu-like symptoms, which occurred suddenly at home and were not preceded by hospitalization or execution of nasopharyngeal swabs. The aim of this report is to highlight histopathologic pattern detected at light microscopy (H&E) survey attempting to correlate them with conceivable pathophysiology of the COVID19 viral attack.
Cases report Forensic autopsies were performed on two Caucasian women, respectively, 67 and 61 years old, who suddenly died after 1 week of persistent flu-like symptoms accompanied by low-grade fever that does not require hospitalization. Deaths occurred at home were preceded by sudden onset of a rapidly worsening dyspnea and anticipated intervention of the emergency staff. The 61-year-old woman was affected by non-insulindependent diabetes mellitus and Hashimoto’s thyroiditis treated with dai
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