Sudden Unexpected Death Due to Myocarditis Caused by Coronavirus Disease 2019: Postmortem Histopathologic Evaluation
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Coronavirus disease 2019 (COVID-19) is a manifestation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and its major symptoms include pulmonary complications, such as pneumonia. However, it also involves the cardiovascular system and the developed myocarditis can lead to sudden unexpected death. Herein, we present a case in which a patient died four days after release from isolation due to SARS-CoV-2 infection. SARS-CoV-2 was confirmed again during postmortem (PM) inspection at the scene of death. Autopsy revealed myocarditis and evidence of pulmonary involvement with SARS-CoV-2. Pathological examination revealed myocardial perivascular infiltration of lymphocytes and macrophages with multifocally injured cardiomyocytes. The pathological findings of COVID-19–induced myocarditis differ from those of other viral myocarditis, and we assume that different pathophysiological mechanisms could have been responsible for this manifestation. After a comprehensive PM examination, including gross dissection, microscopic examination, PM computed tomography, and PM laboratory tests, the cause and manner of death were determined to be myocarditis caused by COVID-19 and naturally, respectively. This case highlights the significance of autopsy and comprehensive PM examinations in both forensic and public healthcare systems.
Abstract
Coronavirus disease 2019 (COVID-19) is a manifestation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and its major symptoms include pulmonary complications, such as pneumonia. However, it also involves the cardiovascular system and the developed myocarditis can lead to sudden unexpected death. Herein, we present a case in which a patient died four days after release from isolation due to SARS-CoV-2 infection. SARS-CoV-2 was confirmed again during postmortem (PM) inspection at the scene of death. Autopsy revealed myocarditis and evidence of pulmonary involvement with SARS-CoV-2. Pathological examination revealed myocardial perivascular infiltration of lymphocytes and macrophages with multifocally injured cardiomyocytes. The pathological findings of COVID-19–induced myocarditis differ from those of other viral myocarditis, and we assume that different pathophysiological mechanisms could have been responsible for this manifestation. After a comprehensive PM examination, including gross dissection, microscopic examination, PM computed tomography, and PM laboratory tests, the cause and manner of death were determined to be myocarditis caused by COVID-19 and naturally, respectively. This case highlights the significance of autopsy and comprehensive PM examinations in both forensic and public healthcare systems.
참고문헌 (18)
- Agdamag AC, "Update on COVID-19 myocarditis", Medicina(Kaunas), 56, pp.678~ (2020)
- Huang Y, "Structural and functional properties of SARS-CoV-2 spike protein : potential antivirus drug development for COVID-19", Acta Pharmacol Sin, 41, pp.1141~1149 (2020)
- Esakandari H, "A comprehensive review of COVID-19 characteristics", Biol Proced Online, 22, pp.19~ (2020)
- Esfandiarei M, "Molecular biology and pathogenesis of viral myocarditis", Annu Rev Pathol, 3, pp.127~155 (2008)
- Caforio AL, "and therapy of myocarditis : a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases", Eur Heart J, 34, pp.2636~2648 (2013)
- 허진행, "Fatal Pneumonia Caused by Omicron Subvariant BA.2 of Severe Acute Respiratory Syndrome Coronavirus 2 with the Pulmonary Tuberculosis", 대한법의학회지, 46(3), pp.79~84 (2022), 대한법의학회[DOI]
- Xiong TY, "Coronaviruses and the cardiovascular system : acute and long-term implications", Eur Heart J, 41, pp.1798~1800 (2020)
- Kang Y, "Cardiovascular manifestations and treatment considerations in COVID-19", Heart, 106, pp.1132~1141 (2020)
- Kyto V, "Diagnosis and presentation of fatal myocarditis", Hum Pathol, 36, pp.1003~1007 (2005)
- Castiello T, "COVID-19and myocarditis : a systemic review and overview of current challenges", Heart Fail Rev, 27, pp.251~261 (2022)
- Halushka MK, "Myocarditis is rare in COVID-19autopsies : cardiovascular findings across 277 postmortem examinations", Cardiovasc Pathol, 50, pp.107300~ (2021)
- Ouyang J, "Utility of desmin and a Masson's trichrome method to detect early acute myocardial infarction in autopsy tissues", Int J Clin Exp Pathol, 3, pp.98~105 (2009)
- Bozkurt B, "Myocarditis with COVID-19 mRNA vaccines", Circulation, 144, pp.471~484 (2021)
- Tavazzi G, "Myocardial localization of coronavirus in COVID-19 cardiogenic shock", Eur J Heart Fail, 22, pp.911~915 (2020)
- Fox SE, "COVID-19 myocarditis : quantitative analysis of the inflammatory infiltrate and a proposed mechanism", Cardiovasc Pathol, 54, pp.107361~ (2021)
- Kang DH, "Fulminant giant cell myocarditis following heterologous vaccination of ChAdOx1 nCoV-19 and Pfizer-BioNTech COVID-19", Medicina(Kaunas), 58, pp.449~ (2022)
- Sung K, "Biopsy-proven giant cell myocarditis following the COVID-19 vaccine", Circ Heart Fail, 15, pp.e009321~ (2022)
- 박소형, "Sudden Cardiac Death Caused by Small Vessel Vasculitis After COVID-19 vaccination (BNT162b2 nCov-19); A Case Report", 대한법의학회지, 45(4), pp.133~138 (2021), 대한법의학회[DOI]