scholarly journals Postmortem Findings in Patients with COVID19 Using Multiple Organ Core Needle Biopsies

2021 ◽  
Vol 156 (Supplement_1) ◽  
pp. S23-S23
Author(s):  
Z F Harb ◽  
J Mueller ◽  
A Khan ◽  
N Ravikumar ◽  
M Tidswell
Keyword(s):  
Electron Microscopy ◽  
Respiratory Symptoms ◽  
Histopathological Examination ◽  
Systemic Disease ◽  
The United States ◽  
Multiple Organ ◽  
Postmortem Examination ◽  
White Pulp ◽  
Core Needle ◽  
Immunohistochemical Stains

Abstract Introduction/Objective The coronavirus disease 2019 (COVID19) pandemic had caused more than 500,000 deaths in the United States. Although it mainly manifests with respiratory symptoms, postmortem examination reveals that it is more of a systemic disease affecting mutliple body organs. Methods/Case Report Postmortem needle core biopsies from multiple organs were obtained from 9 patients who died at our institution in the months of April and May of 2020 due to a confirmed SARS-CoV-2 infection by RT-PCR testing of nasopharyngeal swabs. The core biopsies from body organs included lungs (8), liver (7), kidneys (5), heart (2), spleen (2), and brain (2). Histopathological examination was performed in conjunction with a set of special and immunohistochemical stains. Electron microscopy examination was also done in 4 cases. Results (if a Case Study enter NA) The cohort consisted of 6 males and 3 females with a mean age of 70.4 years (range: 68–79). The majority had comorbidities (8/9) and presented with respiratory symptoms (9/9). The most significant postmortem findings were mainly in the lungs, including alveolar hemorrhage, hyaline membranes, fibrin thrombi, intraalveolar macrophages, type-2 pneumocyte hyperplasia, and interstitial myofibroblast reaction and collagen deposition. Immunohistochemical stains showed predominance of T-lymphocytes with a mixture of CD4 and CD8 positive cells. Examination of liver showed minimal to marked microvesicular and macrovesicular steatosis and centrilobular congestion and necrosis. Tissue from kidneys revealed mild to severe acute tubular injury. Microglial activation and Alzheimer type-II astrocytosis were noted in brain, and mild white pulp depletion was seen in the spleen. Electron microscopy showed the presence of foreign bodies suspicious for viral particles ranging in size from 52.6 to 97.9 nm in 2/4 cases. Conclusion Our findings based on postmortem core needle biopsies confirm the observation that most severely affected patients have significant pulmonary pathology. However, other organs show findings that may lead to a better understanding of this disease. Postmortem examination will continue to be an invaluable tool for studying the pathologic manifestations of COVID-19.

Scanning electron microscopy of asbestos-containing material where the asbestos fibers are considered locked in a binder

1993 ◽  
Vol 51 ◽  
pp. 472-473
Author(s):  
J. R. Millette ◽  
R. S. Brown
Keyword(s):  
Electron Microscopy ◽  
Scanning Electron Microscopy ◽  
Environmental Protection Agency ◽  
Building Materials ◽  
The United States ◽  
Protection Agency ◽  
Asbestos Fibers ◽  
Different Types ◽  
Binder Material ◽  
Scanning Electron

The United States Environmental Protection Agency (EPA) has labeled as “friable” those building materials that are likely to readily release fibers. Friable materials when dry, can easily be crumbled, pulverized, or reduced to powder using hand pressure. Other asbestos containing building materials (ACBM) where the asbestos fibers are in a matrix of cement or bituminous or resinous binders are considered non-friable. However, when subjected to sanding, grinding, cutting or other forms of abrasion, these non-friable materials are to be treated as friable asbestos material. There has been a hypothesis that all raw asbestos fibers are encapsulated in solvents and binders and are not released as individual fibers if the material is cut or abraded. Examination of a number of different types of non-friable materials under the SEM show that after cutting or abrasion, tuffs or bundles of fibers are evident on the surfaces of the materials. When these tuffs or bundles are examined, they are shown to contain asbestos fibers which are free from binder material. These free fibers may be released into the air upon further cutting or abrasion.

scholarly journals A Case of IgG4-Related Kidney Disease Developing While on Steroid Treatment for Autoimmune IgG4 Pancreatitis

2021 ◽  
Vol 9 ◽  
pp. 232470962110265
Author(s):  
Jonathan Vincent M. Reyes ◽  
Dawn Maldonado ◽  
Aaron S. Stern ◽  
Maritza Brown
Keyword(s):  
Kidney Disease ◽  
Inflammatory Process ◽  
Systemic Disease ◽  
Multiple Organ ◽  
Steroid Treatment ◽  
Autoimmune Process ◽  
Immunoglobulin G4 ◽  
Organ Systems ◽  
The Relationship ◽  
Steroid Sparing

IgG4 (immunoglobulin G4)-related systemic disease is an autoimmune process affecting multiple organ systems. This inflammatory process can present as but not limited to pancreatitis, cholangitis, or unspecified kidney disease. In this case, our patient developed IgG4-related kidney disease while already on a prolonged steroid course for IgG4-related pancreatitis. The patient ultimately had renal recovery after starting a higher dose of prednisone, but also developed steroid-related complications. This case further highlights the relationship between IgG4 diseases now termed IgG4-related systemic disease. This case brings to light the need for further investigative research into ideal steroid dosing, as well as steroid-sparing agents for IgG4-related systemic disease.

scholarly journals The Ugly Side of Colchicine

2021 ◽  
Vol 9 ◽  
pp. 232470962110297
Author(s):  
Justin Cozza ◽  
Tuong Vi Cassandra Do ◽  
Shyam Ganti ◽  
Jayaramakrishna Depa
Keyword(s):  
Liver Failure ◽  
Acute Liver Failure ◽  
Activated Charcoal ◽  
The United States ◽  
Multiple Organ ◽  
Poison Control ◽  
Fab Fragments ◽  
Early Use ◽  
Potential Use ◽  
Electrolyte Abnormalities

We report a rare case of a 32-year-old male who ingested 32.4 to 54 mg of colchicine and presented after 44 hours. He developed progressive multiple organ failure with shock, acute kidney failure, troponemia, pancytopenia, absolute neutropenia, disseminated intravascular coagulation, acute liver failure, rhabdomyolysis, and lactic acidosis. He also developed electrolyte abnormalities and refractory hypoglycemia. Initial treatment consisted of activated charcoal, fluids, and broad-spectrum antibiotics with supportive treatment of mechanical ventilation, hemodialysis, vasopressors, N-acetylcysteine, colony-stimulating factors, and blood products. Literature shows potential benefit of colchicine-specific Fab fragments for acute toxicity with limited studies and is not currently available in the United States. Further research for N-acetylcysteine protocol for acute liver failure in colchicine toxicity and potential use of colchicine-specific Fab fragments is needed. Our case demonstrates the importance of early use of activated charcoal for ingestion overdose with the incorporation of poison control into multidisciplinary team for coordinated patient care.

A Fatal Case of Powassan Virus Encephalitis

2020 ◽  
Vol 79 (11) ◽  
pp. 1239-1243
Author(s):  
Qiqi Yu ◽  
Eduard Matkovic ◽  
Sarah Reagan-Steiner ◽  
Amy M Denison ◽  
Rebecca Osborn ◽  
...  
Keyword(s):  
Electron Microscopy ◽  
Neuronal Degeneration ◽  
Fatal Case ◽  
Central Nervous System Involvement ◽  
Immunohistochemical Analysis ◽  
The United States ◽  
Nodule Formation ◽  
Powassan Virus ◽  
Life Threatening ◽  
Autopsy Tissues

Abstract Powassan virus (POWV) is a flavivirus of the tick-borne encephalitis serogroup that causes a rare and potentially life-threatening neuroinvasive disease. Viral transmission occurs during zoonotic spillover from mammals by the bite of an infected tick in endemic regions of North America. The number of reported POWV cases has recently increased in the United States. We report a fatal case of POWV meningoencephalomyelitis in Northern Wisconsin following a documented tick bite. Histologic examination of the brain demonstrated widespread intraparenchymal and perivascular lymphohistocytic infiltration, microglial nodule formation, and marked neuronal degeneration, most severely involving the substantia nigra, anterior horn of spinal cord and cerebellum. Although no viral inclusions were seen in routine light microscopy, electron microscopy identified multiple neurons containing cytoplasmic clusters of virus particles ∼50 nm in diameter. POWV infection was confirmed using immunohistochemical analysis and reverse transcription-polymerase chain reaction. This report demonstrates in detail regional central nervous system involvement and ultrastructural characteristics of Powassan viral particles by transmission electron microscopy, while highlighting the utility of evaluating fixed autopsy tissues in cases of unexplained meningoencephalomyelitis.

scholarly journals Inflammatory Skin Lesions in Three SARS-CoV-2 Swab-Negative Adolescents: A Possible COVID-19 Sneaky Manifestation?

2021 ◽  
Vol 13 (2) ◽  
pp. 181-188
Author(s):  
Giuseppe Ingravallo ◽  
Francesco Mazzotta ◽  
Leonardo Resta ◽  
Sara Sablone ◽  
Gerardo Cazzato ◽  
...  
Keyword(s):  
Electron Microscopy ◽  
Respiratory Symptoms ◽  
Clinical Manifestations ◽  
Skin Lesions ◽  
Sweat Glands ◽  
Histological Findings ◽  
Immune Mediated ◽  
Nodular Lesions ◽  
Immunohistochemical Evidence ◽  
Eccrine Sweat Glands

Coronavirus disease 19 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is associated with various clinical manifestations, including skin lesions. In particular, during the COVID-19 pandemic lock-down period numerous chilblain-like lesions, mainly located on the feet, were observed in adolescents. The latter were often asymptomatic or associated with very mild respiratory symptoms. Here, we report three cases of acral nodular lesions in SARS-CoV-2 swab-negative adolescents with histological findings of chronic immune-mediated inflammation and immunohistochemical evidence of SARS-CoV-2 spike glycoproteins in endothelial cells and eccrine sweat glands. In one of these cases, the virus presence was confirmed by electron microscopy.

scholarly journals Chronic liver disease not a significant comorbid condition for COVID-19

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jiahao Lin ◽  
Bingting Bao ◽  
Nigar Anjuman Khurram ◽  
Kasey Halsey ◽  
Ji Whae Choi ◽  
...  
Keyword(s):  
Liver Disease ◽  
Liver Injury ◽  
Chronic Liver Disease ◽  
The United States ◽  
Postmortem Examination ◽  
Chronic Liver ◽  
Critical Groups ◽  
Comorbid Condition ◽  
Central Vein ◽  
Significant Difference

AbstractTo explore the role of chronic liver disease (CLD) in COVID-19. A total of 1439 consecutively hospitalized patients with COVID-19 from one large medical center in the United States from March 16, 2020 to April 23, 2020 were retrospectively identified. Clinical characteristics and outcomes were compared between patients with and without CLD. Postmortem examination of liver in 8 critically ill COVID-19 patients was performed. There was no significant difference in the incidence of CLD between critical and non-critical groups (4.1% vs 2.9%, p = 0.259), or COVID-19 related liver injury between patients with and without CLD (65.7% vs 49.7%, p = 0.065). Postmortem examination of liver demonstrated mild liver injury associated central vein outflow obstruction and minimal to moderate portal lymphocytic infiltrate without evidence of CLD. Patients with CLD were not associated with a higher risk of liver injury or critical/fatal outcomes. CLD was not a significant comorbid condition for COVID-19.

scholarly journals Multiple-System Atrophy in Long-Term Professional Painter: A Case Report

2012 ◽  
Vol 2012 ◽  
pp. 1-5
Author(s):  
Yusa Nagai ◽  
Riko Kitazawa ◽  
Miku Nakagawa ◽  
Munenori Komoda ◽  
Takeshi Kondo ◽  
...  
Keyword(s):  
Multiple System Atrophy ◽  
Medulla Oblongata ◽  
Neurodegenerative Disorder ◽  
Histopathological Examination ◽  
Neuronal Loss ◽  
Cytoplasmic Inclusion ◽  
Multiple Organ ◽  
Old Japanese ◽  
History Of

Introduction. Multiple system atrophy (MSA) is a rare and severe adult-onset, sporadic, and progressive neurodegenerative disorder. Here, we describe an autopsy case of MSA in a long-term professional painter. Although typical glial cytoplasmic inclusion (GCI) was not observed in a routine histological examination, strong α-synuclein immunostaining in the nucleus confirmed the diagnosis of MSA.Case Presentation. A 48-year-old Japanese man with a long occupational history of professional painter was sent to the emergency room, where he died of multiple organ failure. The patient had suffered tremors and inarticulateness at age 28, developed diabetes at 42 and was diagnosed with spinocerebellar degeneration at 46. A histopathological examination showed severe neuronal loss, gliosis, and tissue rarefaction in the paleostriatum, striate body of the substantia nigra, the pons, and the olivary nucleus of the upper medulla oblongata, intermediolateral of the spinal gray matter (sacral region). α-synuclein-positive GCI in oligodendroglia was occurred in the cerebral cortex, the midbrain, the medulla oblongata, and the spinal cord. These findings confirmed the presence of multiple-system atrophy (OPCA+SDS).Conclusion. Although the pathogenesis of MSA is still unclear, prolonged, and extensive exposure to organic solvents, together with a hyperglycemic morbidity attributed to diabetes, may have contributed to the onset and clinical course of the present case.

scholarly journals E-cigarette use and adverse respiratory symptoms among adolescents and Young adults in the United States

2021 ◽  
pp. 106766
Author(s):  
Benjamin W. Chaffee ◽  
Jessica Barrington-Trimis ◽  
Fei Liu ◽  
Ran Wu ◽  
Rob McConnell ◽  
...  
Keyword(s):  
United States ◽  
Young Adults ◽  
Respiratory Symptoms ◽  
The United States ◽  
Adolescents And Young Adults ◽  
Cigarette Use

scholarly journals Severe Austrian Syndrome in an Immunocompromised Adult Patient – A Case Report

2018 ◽  
Vol 4 (1) ◽  
pp. 17-22 ◽  
Author(s):  
Ioana Raluca Chirteș ◽  
Dragos Florea ◽  
Carmen Chiriac ◽  
Oana Maria Mărginean ◽  
Cristina Mănășturean ◽  
...  
Keyword(s):  
Case Report ◽  
Streptococcus Pneumoniae ◽  
Histopathological Examination ◽  
Fatal Outcome ◽  
Multiple Organ ◽  
Etiologic Agent ◽  
Acute Meningitis ◽  
History Of ◽  
Valvular Lesions ◽  
Formalin Fixed

AbstractBackground: Known also as Osler’s triad, Austrian syndrome is a complex pathology which consists of pneumonia, meningitis and endocarditis, all caused by the haematogenous dissemination of Streptococcus pneumoniae. The multivalvular lesions are responsible for a severe and potential lethal outcome.Case report: The case of a 51-year-old female patient, with a past medical history of splenectomy, is presented. She developed bronchopneumonia, acute meningitis and infective endocarditis as a result of Streptococcus pneumoniae infection and subsequently developed multiple organ dysfunction syndromes which led to a fatal outcome. Bacteriological tests did not reveal the etiological agent. The histopathological examination showed a severe multivalvular endocarditis, while a PCR based molecular analysis from formalin fixed valvular tissue identified Streptococcus pneumoniae as the etiologic agent.Conclusions: The presented case shows a rare syndrome with a high risk of morbidity and mortality. Following the broad-spectrum treatment and intensive therapeutic support, the patient made unfavourable progress which raised differential diagnosis problems. In this case, the post-mortem diagnosis demonstrated multiple valvular lesions occurred as a result of endocarditis.

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