新冠病毒感染（COVID-19）的后续问题：持续存在的微循环血栓形成、隐匿性感染以及早期肺纤维化是该疾病尚存的挑战。
COVID-19 beyond DAD: Persisting microcirculation thrombosis, hidden infections, and early pulmonary fibrosis as remaining challenges of the disease.
作者信息
Carvalho Lilian V S, da Silva Souza Cassiana, Fontes Jonathan L M, Cardoso Lara, Salomar Milton, Duarte-Neto Amaro Nunes, Figueira Claudio, Brito Reginaldo, Mesquita Bianca, de Freitas Luiz A R, Oliveira Geraldo G S, Dos-Santos Washington L C
机构信息
Instituto Couto Maia, Salvador, BA, Brazil.
Fundação Oswaldo Cruz, Instituto Gonçalo Moniz, Salvador, BA, Brazil.
出版信息
Hum Pathol Rep. 2022 Mar;27:300607. doi: 10.1016/j.hpr.2022.300607. Epub 2022 Feb 28.
BACKGROUND
Despite advances in the management of COVID-19, some events occurring in the course of disease still represent challenges to patient treatment.
CASE PRESENTATION
Here we present a case of severe COVID-19 in which the patient received standard treatment including dexamethasone and prophylactic anticoagulation and died on the 24th day of disease. Autopsy showed exudative and proliferative DAD accompanied by remaining microcirculation thrombosis despite anticoagulation treatment, unperceived fungal infection, concomitantly with the presence of dense acellular fibrotic areas amidst organizing lung lesions.
CONCLUSIONS
Although improvements were achieved in COVID-19 therapeutics lung microcirculation coagulopathy, unperceived fungus infection and early developing alveolar fibrosis remain unsolved problems associated to the disease.
背景
尽管在新型冠状病毒肺炎（COVID-19）的管理方面取得了进展，但疾病过程中发生的一些事件仍然对患者治疗构成挑战。
病例报告
在此，我们报告一例重症COVID-19病例，该患者接受了包括地塞米松和预防性抗凝在内的标准治疗，并在疾病第24天死亡。尸检显示存在渗出性和增殖性弥漫性肺泡损伤（DAD），尽管进行了抗凝治疗，但仍有微循环血栓形成，存在未被察觉的真菌感染，同时在机化性肺病变中有密集的无细胞纤维化区域。
结论
尽管COVID-19治疗在肺微循环凝血病方面取得了进展，但未被察觉的真菌感染和早期肺泡纤维化仍然是与该疾病相关的未解决问题。
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