Histopathogical Lung Patterns of SARS CoV2 Infection

Abstract

INTRODUCTION: residual lung injury in patients recovering from COVID-19 information is scarce. Herein, we present a previous confirmed SARS-CoV2 infection case series including five patients, who underwent either open or transbronchial lung biopsy due to no clinical improvement. DESCRIPTION: Case 1: a 73-year-old male patient initially asymptomatic, with positive RT-PCR after transurethral resection of the prostate. Consulted for dyspnea and room air desaturation after 24 days during postoperative. Chest computed tomography reported findings compatible with organizing pneumonia, then a transbronchial biopsy was performed confirming diagnosis. Case 2: a 48-year-old male patient with COVID-19 pneumonia who required 14 days hospitalization. He was readmitted after 25 days since initial symptoms due to dyspnea and room air desaturation with a chest CT that revealed findings suggestive of pulmonary fibrosis. Therefore, an open lung biopsy was performed with a probable usual interstitial pneumonia pattern report. Case 3: a 86-year-old male patient, with initial mild COVID-19 infection who later progressed to severe pneumonia requiring high levels of supplemental oxygen. At 18 days of admission, due to persistent clinical compromise, a chest CT was performed with findings of organizing pneumonia. Therefore, he was taken to transbronchial lung biopsy that revealed non-specific interstitial pneumonia in the fibrosing phase. Case 4: a 61-year-old male patient with HIV/AIDS infection presented acute respiratory distress syndrome due to severe COVID-19 pneumonia with inability to withdraw invasive mechanical ventilation after one month. An open lung biopsy was performed with histopathology diagnosis of diffuse alveolar damage in the proliferative phase.Case 5: 41-year-old male patient with severe COVID-19 pneumonia requiring invasive mechanical ventilation, with persistent use of high levels of supplemental oxygen after 30 days since symptomatic. The chest CT suggested pulmonary fibrosis;therefore, an open lung biopsy was performed and confirmed Non-Specific Interstitial Pneumonia. DISCUSSION: to date, reports of interstitial lung disease due to COVID-19 refer to imaging findings or post-mortem histopathological studies which have been relatively limited given the strict guidelines and restrictions for performing bronchoscopies and lung surgery during the pandemic. The foregoing highlights the importance of tissue analysis under rigorous safety protocols in order to provide an early detection of interstitial lung involvement secondary to SARS-CoV-2 infection and then evaluate a prolonged steroid treatment recommendation.