Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
JAMA Ophthalmol. 2022 Apr 1;140(4):312-318. doi: 10.1001/jamaophthalmol.2021.6364.
Pathological features of ophthalmic aftereffects of COVID-19 are important for new insight in treating patients.
To examine the expression of SARS-CoV-2 nucleocapsid protein and angiotensin-converting enzyme 2 (ACE2) in lacrimal gland tissues of a patient with COVID-19 and a patient without COVID-19.
DESIGN, SETTING, AND PARTICIPANTS: In this retrospective case-control study, the case of a 35-year-old woman with positive test results for SARS-CoV-2 who had had lacrimal gland enlargements for 6 months was analyzed. A 43-year-old woman without COVID-19 who had idiopathic chronic bilateral dacryoadenitis served as a negative control.
Histopathology and immunohistochemistry with anti-SARS-CoV-2 nucleocapsid protein and ACE2 in the lacrimal glands.
Both patients were Japanese women aged 35 years (case) and 43 years (control). Histopathologic findings in the patient with COVID-19 demonstrated marked inflammatory cell infiltration, lymphoid follicles, and germinal center formation in the lacrimal gland. The inflammation was mainly made up of lymphocytes and plasma cells with several polymorphonuclear leukocytes, where the lacrimal glands were atrophic. Of note, a number of lacrimal gland ducts markedly contained eosinophilic materials in the lumens, which indicated glandular damage. Immunoreactivity for SARS-CoV-2 nucleocapsid protein was noted in the inflammatory cells around the lacrimal gland ductal epithelia. In addition, strong ACE2 expression was noted in the lacrimal gland. In the patient without COVID-19, marked inflammation was noted in the lacrimal gland; however, there were no eosinophilic material deposits in the ductal lumens. SARS-CoV-2 nucleocapsid protein immunoreactivity was not observed, whereas ACE2 was expressed in the lacrimal glands.
In this case-control study, expression of ACE2 indicated that the lacrimal gland could be a target organ for SARS-CoV-2 to adhere to. Chronic bilateral dacryoadenitis in the patient with COVID-19 showed SARS-CoV-2-positive inflammatory cells with glandular damage, which might be a COVID-19-associated ophthalmic aftereffect.
COVID-19 眼部后遗症的病理特征对于治疗患者具有新的启示。
检查 COVID-19 患者和非 COVID-19 患者的泪腺组织中 SARS-CoV-2 核衣壳蛋白和血管紧张素转换酶 2（ACE2）的表达。
设计、设置和参与者：在这项回顾性病例对照研究中，分析了一位 35 岁女性的病例，该女性 SARS-CoV-2 检测结果呈阳性，且有 6 个月的泪腺肿大病史。一位 43 岁的无 COVID-19 的日本女性因特发性慢性双侧泪腺炎作为阴性对照。
泪腺的组织病理学和免疫组织化学检查，使用抗 SARS-CoV-2 核衣壳蛋白和 ACE2 的抗体。
两名患者均为 35 岁（病例）和 43 岁（对照）的日本女性。COVID-19 患者的组织病理学发现，泪腺中有明显的炎症细胞浸润、淋巴滤泡和生发中心形成。炎症主要由淋巴细胞和浆细胞组成，伴有几个多形核白细胞，泪腺萎缩。值得注意的是，许多泪腺导管腔中明显含有嗜酸性物质，表明腺体受损。在泪腺导管上皮周围的炎症细胞中检测到 SARS-CoV-2 核衣壳蛋白的免疫反应性。此外，在泪腺中也观察到强烈的 ACE2 表达。在非 COVID-19 患者中，泪腺中也有明显的炎症，但导管腔中没有嗜酸性物质沉积。未观察到 SARS-CoV-2 核衣壳蛋白免疫反应性，而 ACE2 在泪腺中表达。
在这项病例对照研究中，ACE2 的表达表明泪腺可能是 SARS-CoV-2 附着的靶器官。COVID-19 患者的慢性双侧泪腺炎表现为 SARS-CoV-2 阳性的炎症细胞和腺体损伤，这可能是 COVID-19 相关的眼部后遗症。
