Introduction:

The objective of the study is to describe the clinical, pathological, virological and genetic characteristics of the immune response of patients diagnosed with SARS-CoV-2 infection and its relationship with the unfavorable course of the disease.

Methods:

Descriptive, relational, longitudinal and retrospective study based on the review of medical records, taking post-mortem tru-cut biopsies of the lung and liver, taking blood samples and naso-oropharyngeal swab or endotracheal tube aspirate. In the first phase, the biopsies will be processed and studied with conventional and immunohistochemical histology in the Pathological Anatomy service of the Carlos Seguín Escobedo National Hospital in Arequipa, Peru.

Results:

Advanced mean age, male sex, and the presence of comorbidities were predominant in deceased patients. Lung biopsies showed predominantly the exudative and partially proliferative phases of diffuse and focal alveolar damage, and acute organizational and fibrinoid pneumonia, associated primarily with intraalveolar macrophage hyperplasia with accumulation within the alveolar space-resembling desquamative pneumonia, as well as binucleated intraalveolar pneumocytes and atypical, with eosinophilic nucleoli (similar to virocytes) in some cases. In the vast majority of cases, intravascular fibrin deposits associated with the accumulation of inflammatory cells composed of neutrophils and monocytes, representing microthrombosis, were observed. Liver biopsies showed predominantly macrovesicular steatosis and in two cases microvesicular steatosis was observed. Additionally, varying degrees of necrosis and mild portal and lobular inflammation were observed.

Conclusion:

The clinical and pathological findings in this first report are consistent with previous publications and confirm the pattern of diffuse alveolar damage associated with aggregates of intraalveolar macrophages and microthrombosis in addition, macro and microvesicular hepatocytic steatosis, together with variable degrees of necrosis.

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