The course of COVID-19 with the development of “shock organs — lungs and heart”

The article presents a clinical and morphological description of a case involving death upon admission to a hospital, marked by developed sepsis and septic shock caused by the addition of bacterial flora. It also presents a clinical and morphological description of the development of “shock organs — lungs and heart” after infection with SARS-CoV-2.

A 38-year-old patient was hospitalized diagnosed with severe coronavirus infection, leading to shock. Complications arising from the underlying disease included bilateral viral interstitial pneumonia. Virological analysis of throat and nose swap samples confirmed SARS-CoV-2 coronavirus RNA. The patient’s condition, evaluated on the NEWS2 scale, scored 18 points. C-reactive protein levels were measured at 117 mg/l, and procalcitonin level was 9 ng/ml. Despite treatment efforts, the patient did not survive. Sectional examination in the lungs showed focal atelectasis of various sizes, edema with a large number of red blood cells. In the alveoli, there are fibrin threads and “hyaline membranes” — blood stasis in the microcirculatory bed. In the heart, uneven blood filling in vessels, subendocardial hemorrhages, dystrophic and necrobiotic changes in cardiomyocytes, small foci of necrosis, fragmentation of cardiomyocytes, and intermuscular edema were noted. In the described case, the patient developed an infectious-toxic shock with severe changes in the lungs and heart attributed to a SARS-CoV-2 infection. These changes were intensified because of the addition and activation of bacterial flora due to a violation of the barrier function of the lung epithelium, leading to its complete destruction.