THE CASE OF COVID-19 WITH ATYPICAL PULMONARY LESIONS AND A LIFETIME HISTOLOGICAL EXAMINATION

Abstract

THE CASE OF COVID-19 WITH ATYPICAL PULMONARY LESIONS AND A LIFETIME HISTOLOGICAL EXAMINATION О. M. Rekalova, I. V. Liskina, E. M. Maetnyi, M. I. Kulyk Abstract The case of atypical destructive pulmonary lesions associated with the COVID-19 is presented in 42 years old man without significant comorbidity. COVID-19 was not confirmed by naso-pharyngeal smear PCR test at 7th and 28th days of the disease, and by serum SARS-CoV-2 antibody at 11th and 29th day. Chest computed tomography demonstrated the pattern of bilateral multifocal pneumonia with infiltration and cavitation in the acute phase. The video-thoracoscopic edge resection of S5 of the left lung was performed on the 34th day of the disease. Mosaic lung lesions were revealed at histological examination: poorly delimited focal infiltrates, severe productive-necrotic inflammation of the microcirculatory vessels, plasma and red blood cell diapedesis, macrophages reaction, disthelectasis zones, microcysts. The development of cysts of various size could be a consequence of post-inflammatory scaring emphysema and distelectasis with dilatation of vessels with a damaged wall. IgG antibodies to the nucleocapsid protein of SARS-Cov-2 were detected in blood at day 62 after the onset of the disease. Thus, the patient was diagnosed with moderate COVID-19 with destructive pneumonia, not associated with bacterial / mycobacterial / fungal infection, and with vasculitis, and probable microthrombosis of lung vessels, followed by resolution and development of minor residual fibrotic and emphysematous focci. Key words: COVID-19, atypical pulmonary lesions, lung cavitation, lifetime histological examination, morphological changes in the lungs. Ukr. Pulmonol. J. 2021;29(3):41–47.