Autopsy and Case Reports https://autopsyandcasereports.org/article/doi/10.4322/acr.2020.194
Autopsy Case Report
Coronavirus 229E with Rhinovirus co-infection causing severe acute respiratory distress syndrome with thrombotic microangiopathy and death during Covid-19 pandemic: lessons to be learnt
We report on a 3-month old infant male who had a seven-days history of fever and rhinorrhea associated with wheezing prior to his death, during the Covid-19 pandemic. Viral testing for Covid-19 (SARS-CoV-2) was negative but was positive for Coronavirus 229E and RP Human Rhinovirus. The pulmonary histological examination showed diffuse alveolar damage along with thrombotic microangiopathy affecting alveolar capillaries. Also, thrombotic microangiopathy was evident in the heart, lungs, brain, kidneys and liver. Thrombotic microangiopathy is a major pathologic finding in Acute Respiratory Distress Syndrome and in the multiorgan failure. This is the first report that illustrates thrombotic microangiopathy occurring in lung, heart, liver, kidney and brain in Acute Respiratory Distress Syndrome with Coronavirus 229E with Rhinovirus co-infection. The clinical presentation and pathological findings in our case share common features with Covid-19.
NguS, PervaizS, AvulaA, ChalhoubM. Rhinovirus-induced rapidly progressing acute respiratory distress syndrome in an immunocompetent host. Cureus. 2019;11(2):e3997. [https://doi.org/10.7759/cureus.3997]. [PMID:30989006]
VassilaraF, SpyridakiA, PothitosG, DeliveliotouA, PapadopoulosA. A rare case of human Coronavirus 229E associated with acute respiratory distress syndrome in a healthy adult. Case Rep Infect Dis. 2018;2018:6796839. [PMID:29850307]
WhyteCS, MorrowGB, MitchellJL, ChowdaryP, MutchN. Fibrinolytic abnormalities in acute respiratory distress syndrome (ARDS) and versality of thrombolytic drugs to treat COVID-19. J Thromb Haemost. 2020;jth.14872. [https://doi.org/10.1111/jth.14872]. [PMID:32329246]
DolhikoffM, Durate-NetoAN, MonteiroRA, et al. Pathological evidence of pulmonary thrombotic phenomena in severe Covid-19. J Thromb Haemost. 2020;18(6):1517-9. [https://doi.org/10.1111/jth.14844]. [PMID:32294295]
WangJ, HajizadehN, MooreEE, et al. Tissue Plasminogen Activator (tPA) treatment for COVID‐19 Associated Acute Respiratory Distress Syndrome (ARDS): a case series. J Thromb Haemost. 2020;jth.14828. [https://doi.org/10.1111/jth.14828]. [PMID:32267998]
ConnollyAJ, FinkbeinerWE, UrsellPC, DavisRL. Autopsy pathology: a manual and atlas. Philadelphia: Elsevier; 2016. Appendix B.
NairH, SimõesEA, RudanI, et al. Global and regional burden of hospital admissions for severe acute lower respiratory infections in young children in 2010: a systematic analysis. Lancet. 2013;381(9875):1380-90. [https://doi.org/10.1016/S0140-6736(12)61901-1]. [PMID:23369797]
MatsunoAK, GagliardiTB, PaulaFE, et al. Human coronavirus alone or in co-infection with rhinovirus C is a risk factor for severe respiratory disease and admission to the paediatric intensive care unit: a one-year study in Southeast Brazil. PLoS One. 2019;14(6):e0217744. [https://doi.org/10.1371/journal.pone.0217744]. [PMID:31158256]
CalvoC, García-GarcíaML, BlancoC, et al. Multiple simultaneous viral infections in infants with acute respiratory tract infections in Spain. J Clin Virol. 2008;42(3):268-72. [https://doi.org/10.1016/j.jcv.2008.03.012]. [PMID:18455958]
UpadhyayBP, BanjaraMR, ShresthaRK, TashiroM, GhimireP. Etiology of coinfections in children with Influenza during 2015/16 winter season in Nepal. Int J Microbiol. 2018;2018:8945142. [https://doi.org/10.1155/2018/8945142]. [PMID:30510579]
LazzeriniM, SonegoM, PellegrinMC. Hypoxaemia as a mortality risk factor in acute lower respiratory infections in children in low and middle-income Countries: systematic review and meta-analysis. PLoS One. 2015;10(9):e0136166. [https://doi.org/10.1371/journal.pone.0136166]. [PMID:26372640]
SonegoM, PellegrinMC, BeckerG, LazzeriniM. Risk factors for mortality from acute lower respiratory infections (ALRI) in children under five years of age in low and middle-income countries: a systematic review and meta-analysis of observational studies. PLoS One. 2015;10(1):e0116380. [https://doi.org/10.1371/journal.pone.0116380]. [PMID:25635911]
BeasleyMB. The pathologist’s approach to acute lung injury. Arch Pathol Lab Med. 2010;134(5):719-27. [PMID:20441502]
AckermannM, VerledenSE, KuehnelM, et al. Pulmonary vascular endothelialitis, thrombosis, and angiogenesis in Covid-19. N Engl J Med. 2020;NEJMoa2015432. [https://doi.org/10.1056/NEJMoa2015432]. [PMID:32437596]
FrantzeskakiF, ArmaganidisA, OrfanosSE. Immunothrombosis in acute respiratory distress syndrome: cross talks between inflammation and coagulation. Respiration. 2017;93(3):212-25. [https://doi.org/10.1159/000453002]. [PMID:27997925]
GreeneR, LindS, JantschH, et al. Pulmonary vascular obstruction in severe ARDS: angiographic alterations after i.e. fibrinolytic therapy. AJR Am J Roentgenol. 1987;148(3):501-8. [https://doi.org/10.2214/ajr.148.3.501]. [PMID:3492876]
ReedSE. The behaviour of recent isolates of human respiratory coronavirus in vitro and in volunteers: evidence of heterogeneity among 229E‐related strains. J Med Virol. 1984;13(2):179-92. [https://doi.org/10.1002/jmv.1890130208]. [PMID:6319590]
HeY, ZhouY, WuH, KouZ, LiuS, JiangS. Mapping of antigenic sites on the nucleocapsid protein of the severe acute respiratory syndrome coronavirus. J Clin Microbiol. 2004;42(11):5309-14. [https://doi.org/10.1128/JCM.42.11.5309-5314.2004]. [PMID:15528730]
ShiratoK, ImadaY, KawaseM, NakagakiK, MatsuyamaS, TaguchiF. Possible involvement of infection with human coronavirus 229E, but not NL63, in Kawasaki disease. J Med Virol. 2014;86(12):2146-53. [https://doi.org/10.1002/jmv.23950]. [PMID:24760654]
VerdoniL, MazzaA, GervasoniA, et al. An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study. Lancet. 2020;395(10239):1771-8. [https://doi.org/10.1016/S0140-6736(20)31103-X]. [PMID:32410760]
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