tetano
Editor, Senior Moderator
Int J Surg Pathol
. 2024 Dec;32(8):1595-1601.
doi: 10.1177/10668969241236704. Epub 2024 Apr 2. The Histopathologic Features of Early COVID Pneumonia in a Pediatric Patient: New Insight into the Role of Macrophages
Philip L Bulterys[SUP] 1 [/SUP], Guangwu Xu[SUP] 1 [/SUP], Benjamin A Pinsky[SUP] 1 [/SUP], Megan L Troxell[SUP] 1 [/SUP], Joshua R Menke[SUP] 1 [/SUP], Gerald J Berry[SUP] 1 [/SUP], Sebastian Fernandez-Pol[SUP] 1 [/SUP], Florette K Hazard[SUP] 1 [/SUP]
Affiliations
A life-threatening complication of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection is acute respiratory distress syndrome. Our understanding of the pathologic changes in coronavirus disease 2019 (COVID-19) is based almost exclusively on post-mortem analyses of adults. These studies established several hallmarks of SARS-CoV-2 lung infection, including diffuse alveolar damage, microvascular thrombi, and acute bronchopneumonia. We describe a fatal example of COVID pneumonia in a 9-year-old girl who presented with fever 10 months following the diagnosis of ALK-positive anaplastic large cell lymphoma (ALCL). A chest computed tomography scan revealed left upper lobe lung consolidation and nodular airspace disease, and an initial SARS-CoV-2 nasopharyngeal swab (RT-PCR) was negative. A subsequent lung biopsy performed due to concern for relapsed ALCL demonstrated sheets of intra-alveolar and interstitial macrophages, and macrophage-rich fibrinous exudates. Immunohistochemical and in-situ hybridization stains confirmed these macrophages as the predominant SARS-CoV-2-infected cell type. Subsequent RT-PCR testing of upper and lower respiratory tract samples was positive for SARS-CoV-2 infection. Whole genome sequencing confirmed the presence of the B.1.617.2 (Delta) variant. This biopsy illustrates the histopathologic features of early COVID pneumonia in antemortem lung tissue from a pediatric patient, and establishes macrophages as a potential source of SARS-CoV-2 amplification.
Keywords: COVID; SARS-CoV-2; early; pediatric; pneumonia.
. 2024 Dec;32(8):1595-1601.
doi: 10.1177/10668969241236704. Epub 2024 Apr 2. The Histopathologic Features of Early COVID Pneumonia in a Pediatric Patient: New Insight into the Role of Macrophages
Philip L Bulterys[SUP] 1 [/SUP], Guangwu Xu[SUP] 1 [/SUP], Benjamin A Pinsky[SUP] 1 [/SUP], Megan L Troxell[SUP] 1 [/SUP], Joshua R Menke[SUP] 1 [/SUP], Gerald J Berry[SUP] 1 [/SUP], Sebastian Fernandez-Pol[SUP] 1 [/SUP], Florette K Hazard[SUP] 1 [/SUP]
Affiliations
- PMID: 39435671
- DOI: 10.1177/10668969241236704
A life-threatening complication of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection is acute respiratory distress syndrome. Our understanding of the pathologic changes in coronavirus disease 2019 (COVID-19) is based almost exclusively on post-mortem analyses of adults. These studies established several hallmarks of SARS-CoV-2 lung infection, including diffuse alveolar damage, microvascular thrombi, and acute bronchopneumonia. We describe a fatal example of COVID pneumonia in a 9-year-old girl who presented with fever 10 months following the diagnosis of ALK-positive anaplastic large cell lymphoma (ALCL). A chest computed tomography scan revealed left upper lobe lung consolidation and nodular airspace disease, and an initial SARS-CoV-2 nasopharyngeal swab (RT-PCR) was negative. A subsequent lung biopsy performed due to concern for relapsed ALCL demonstrated sheets of intra-alveolar and interstitial macrophages, and macrophage-rich fibrinous exudates. Immunohistochemical and in-situ hybridization stains confirmed these macrophages as the predominant SARS-CoV-2-infected cell type. Subsequent RT-PCR testing of upper and lower respiratory tract samples was positive for SARS-CoV-2 infection. Whole genome sequencing confirmed the presence of the B.1.617.2 (Delta) variant. This biopsy illustrates the histopathologic features of early COVID pneumonia in antemortem lung tissue from a pediatric patient, and establishes macrophages as a potential source of SARS-CoV-2 amplification.
Keywords: COVID; SARS-CoV-2; early; pediatric; pneumonia.