Puzović Velibor, Baković Marija, Bubalo Pero, Mayer Davor
General Hospital Dubrovnik, Department of Pathology and Cytology, Roka Mišetića 2, HR-20 000, Dubrovnik, Croatia.
Institute of Forensic Medicine and Criminalistics, School of Medicine, University of Zagreb, Šalata 11, HR-10 000, Zagreb, Croatia.
Forensic Sci Int Rep. 2020 Dec;2:100139. doi: 10.1016/j.fsir.2020.100139. Epub 2020 Sep 12.
Coronavirus 2019 disease (COVID-19) has rapidly evolved into a pandemic during the first months of 2020. The general extent of organ involvement, as well as microscopic changes in the organs of the diseased remains insufficiently documented so far. Herein we are reporting the case of a Caucasian male who apparently died in a workplace allegedly by a fall from height and was found to be SARS-CoV-2 positive just prior to the autopsy. The circumstances of his death required a medicolegal investigation. Gross autopsy findings included minor external injuries and focal subarachnoid hemorrhage together with ribs and sternum fractures resulting from resuscitation attempt. In addition, visceral congestion was noticed, especially visible in lungs. Traumatic findings suitable to explain sudden death were absent. However, lungs histopathology analysis revealed diffuse alveolar damage with massive capillary congestion. Pathology in other organs included myocardial fibrosis, left ventricular hypertrophy, severe generalized atherosclerosis, glomerulosclerosis, focal liver necrosis, liver microabscesses and intrahepatal cholestasis. Lab test confirmed the presence of SARS-CoV-2 in nasopharygeal swab taken postmortem. Only afterwards, the investigation brought out that he was suffering complaints consistent with respiratory infection in the days before death. Based on all findings, the death was ruled as natural, caused by COVID-19. Learnings from this case urge medical staff in the autopsy suite to consider the presence of SARS-CoV-2 in sudden deaths during the pandemic, to enable adequate personal protection gear is worn and to ensure the proper cause of death is determined where misleading circumstances exist.
2019年冠状病毒病（COVID-19）在2020年的头几个月迅速演变成一场大流行病。到目前为止，关于器官受累的总体程度以及患病者器官的微观变化，记录仍然不足。在此，我们报告一例白人男性病例，该男子显然在工作场所坠楼身亡，尸检前被发现SARS-CoV-2呈阳性。其死亡情况需要进行法医学调查。大体尸检结果包括轻微的外部损伤和局灶性蛛网膜下腔出血，以及因复苏尝试导致的肋骨和胸骨骨折。此外，还发现了内脏充血，尤其是在肺部明显可见。没有发现足以解释猝死的创伤性发现。然而，肺部组织病理学分析显示弥漫性肺泡损伤伴大量毛细血管充血。其他器官的病理学表现包括心肌纤维化、左心室肥厚、严重的全身性动脉粥样硬化、肾小球硬化、局灶性肝坏死、肝微脓肿和肝内胆汁淤积。实验室检测证实死后采集的鼻咽拭子中存在SARS-CoV-2。直到后来，调查才发现他在死亡前几天出现了与呼吸道感染相符的症状。基于所有发现，判定死亡为自然死亡，由COVID-19引起。该病例的经验促使尸检室的医务人员在大流行期间考虑猝死病例中是否存在SARS-CoV-2，以便能够穿戴适当的个人防护装备，并确保在存在误导性情况时确定正确的死因。
