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Cardiovascular involvement can also occur, such as thrombosis or myocarditis, generally associated with pulmonary lesions. We report the case of a year-old man suffering from a refractory cardiogenic shock, without significant lung involvement.
A medical autopsy was performed two days after death. The lungs were congestive, without significant hepatization. The heart weighted g. Coronary arteries showed calcified atherosclerosis and contained two permeable stents, localized in the circumflex branch of the left coronary artery and in the right coronary artery. Most of these T lymphocytes were positive for Tia-1 and granzyme B.
Immunohistochemistry for anti-SARS nucleo-capsid protein antibody was strongly positive in myocardial cells, but not in lung tissue. In lung parenchyma, alveolar spaces were focally filled with a fibrine exudate, associated with a mild macrophagic alveolitis, without pneumocytes dystrophy. No fibrosis was seen. Liver parenchyma showed a moderate macro-vacuolated steatosis and an abundant peri-portal fibrosis associated with porto-portal septa.
Multifocal centro-lobular necrosis was also observed, without significant inflammation. Acute tubular necrosis was observed in kidney, without inflammation. Pancreas showed a pluri-focal moderate lymphocytic and macrophagic inflammation and few phenomena of necrosis. In conclusion, this case study thus gives new insights in the pathogenesis of SARS-CoV-2 induced fulminant myocarditis and emphasizes on the importance and reliability of post-mortem analyses.
