Pathology for COVID-19 Pediatric Multisystem Inflammatory Syndrome

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PATHOLOGY from Pediatrics Team

COVID-19 Pathology and Pediatric Multisystem Inflammatory Syndrome by Karen S. Thompson, MD

Severe Acute Respiratory Syndrome Coronavirus 2

1-p1-1-pathology-peds — This illustration of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) shows surface spikes (red), giving a halo appearance incorporated into the name "corona." (From DP: Infectious Diseases.)

Ultrastructural Features

2-p1-2-pathology-peds — This transmission electron micrograph shows spherical extracellular particles with surface spikes and cross sections through the viral genome (black dots), features characteristic of SARS-CoV-2. (From DP: Infectious Diseases.)

Chest X-Ray

3-p1-3-pathology-peds — This portable chest X-ray shows parenchymal opacities with asymmetric distribution, consolidation in the right perihilar region, and opacity in left lung base, findings consistent with coronavirus disease 2019 (COVID-19) pneumonia. (From DP: Infectious Diseases.)

Gross Features

4-p1-4-pathology-peds — This section of lung from a fatal case of COVID-19 shows areas of red congested and edematous parenchyma, consistent with diffuse alveolar damage. (From DP: Infectious Diseases.)

Hyaline Membranes

5-p6-1-pathology-peds — Early histologic findings in COVID-19 pneumonia include eosinophilic hyaline membranes, consistent with exudative (acute) diffuse alveolar damage. (From DP: Infectious Diseases.)

Interstitial Inflammation and Edema

6-p6-2-pathology-peds — COVID-19 pneumonia includes variable amounts of interstitial and perivascular chronic inflammation and edema. (From DP: Infectious Diseases.)

Fibrin Thrombi

7-p6-3-pathology-peds — Fibrin thrombi involving small vessels are occasionally present in COVID-19 pneumonia. (From DP: Infectious Diseases.)

Multinucleated Giant Cells

8-p6-4-pathology-peds — Multinucleated giant cells with prominent reactive-appearing nucleoli are variably present in COVID-19 pneumonia. (From DP: Infectious Diseases.)

Lymphophagocytosis

9-p6-5-pathology-peds — A reactive histiocyte is present containing an engulfed lymphocyte that should not be confused with a viral inclusion. (From DP: Infectious Diseases.)

Fibroblast Proliferation

10-p6-6-pathology-peds — Fibroblast proliferation and collagen production in alveolar spaces reflect organized alveolar damage. (From DP: Infectious Diseases.)

Hippocampus: High Power

d1-pathology-peds — Acute hypoxic Ischemic changes can be seen in hippocampal neurons from a COVID-19 patient. The neurons are red and pyknotic (20x magnification). (Courtesy I. H. Solomon, MD, PhD.)

Cerebellum

d2-pathology-peds — Sections of the cerebellum in a patient with COVID-19 infection show acute hypoxic ischemic injury in the form of red neurons and Purkinje cell dropout (10x magnification). (Courtesy I. H. Solomon, MD, PhD.)

Temporal Lobe, Low Power: Leukocyte Common Antigen

d3-pathology-peds — Low-power view of the temporal lobe in a patient infected with COVID-19 shows perivascular inflammation and microglial activation, highlighted on a leukocyte common antigen stain (LCA, CD45) (10x magnification). (Courtesy I. H. Solomon, MD, PhD.)

Temporal Lobe, High Power: Leukocyte Common Antigen

d4-pathology-peds — Perivascular inflammation can be seen on a leukocyte common antigen (LCA, CD45) stain of the temporal lobe of a patient infected with COVID-19. Surrounding parenchymal microglia are also highlighted (40x magnification). (Courtesy I. H. Solomon, MD, PhD.)

Olfactory Nerve

d5-pathology-peds — Early histologic findings in COVID-19 pneumonia include eosinophilic hyaline membranes, consistent with exudative (acute) diffuse alveolar damage. (From DP: Infectious Diseases.)

Frontal Lobe: Perivascular Inflammation

d6-pathology-peds — Sections of the frontal lobe of a COVID-19 patient show a chronic perivascular inflammatory infiltrate (20x magnification). (Courtesy I. H. Solomon, MD, PhD.)

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