COVID-19 Pathology and Pediatric Multisystem Inflammatory Syndrome by Karen S. Thompson, MD
Severe Acute Respiratory Syndrome Coronavirus 2
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
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
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
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
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
COVID-19 pneumonia includes variable amounts of interstitial and perivascular chronic inflammation and edema. (From DP: Infectious Diseases.)
Fibrin Thrombi
Fibrin thrombi involving small vessels are occasionally present in COVID-19 pneumonia. (From DP: Infectious Diseases.)
Multinucleated Giant Cells
Multinucleated giant cells with prominent reactive-appearing nucleoli are variably present in COVID-19 pneumonia. (From DP: Infectious Diseases.)
Lymphophagocytosis
A reactive histiocyte is present containing an engulfed lymphocyte that should not be confused with a viral inclusion. (From DP: Infectious Diseases.)
Fibroblast Proliferation
Fibroblast proliferation and collagen production in alveolar spaces reflect organized alveolar damage. (From DP: Infectious Diseases.)
Hippocampus: High Power
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
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
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
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
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
Sections of the frontal lobe of a COVID-19 patient show a chronic perivascular inflammatory infiltrate (20x magnification). (Courtesy I. H. Solomon, MD, PhD.)