SARS-Cov-2 fulminant myocarditis: an autopsy and histopathological case study.
SARS-Cov-2 fulminant myocarditis: an autopsy and histopathological case study.
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SARS-CoV-2暴发型心肌炎：尸检和组织病理学病例研究。
DOI：
10.1007/s00414-020-02500-z
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发表时间：
2021-03
影响因子：
2.1
通讯作者：
Louis G
中科院分区：
文献类型：
--
作者：
Gauchotte G;Venard V;Segondy M;Cadoz C;Esposito-Fava A;Barraud D;Louis G
由SARS-CoV-2引起的2019冠状病毒病（COVID-19）主要是一种呼吸道疾病，在大多数严重病例中会导致危及生命的急性呼吸窘迫综合征（ARDS）。也可能发生心血管受累，如血栓形成或心肌炎，通常与肺部病变有关。关于SARS-CoV-2引起的心肌炎知之甚少。我们报告的情况下，69岁的男子患有难治性心源性休克，没有显着的肺部参与。在死亡前，采集了几份鼻咽拭子和远端支气管肺泡灌洗液，以进行SARS-CoV-2-RNA的RT-PCR分析，结果均为阴性。尸检显示冠状动脉粥样硬化，无急性并发症。心脏的显微镜检查显示在心室和隔膜中存在强烈的多灶性炎性浸润，主要由巨噬细胞和CD 8+细胞毒性T淋巴细胞组成（CD 4/CD 8比值：0.11）。抗SARS核蛋白抗体免疫组化在心肌细胞中呈强阳性，而在肺组织中不呈阳性。在福尔马林固定的石蜡包埋的肺和心脏组织块上实现RT-PCR：只有心脏组织对SARS-CoV-2 RNA呈阳性。总之，这一详尽的暴发性心肌炎尸检病理病例研究表明，心脏组织中存在SARS-CoV-2 RNA，而肺部无明显受累。免疫组化显示病毒特异性定位于心肌细胞，并诱导强烈的细胞毒性T细胞炎症反应。因此，本病例报告对SARS-CoV-2诱导的心肌炎的发病机制提供了新的见解，并强调了尸检分析的重要性和可靠性，以便更好地了解这种全球传播的新病毒性疾病的生理病理学。
The coronavirus disease 2019 (COVID-19), due to SARS-CoV-2, is primarily a respiratory disease, causing in most severe cases life-threatening acute respiratory distress syndrome (ARDS). Cardiovascular involvement can also occur, such as thrombosis or myocarditis, generally associated with pulmonary lesions. Little is known about SARS-CoV-2-induced myocarditis. We report the case of a 69-year-old man suffering from a refractory cardiogenic shock, without significant lung involvement. Prior to death, several nasopharyngeal swabs and distal bronchoalveolar lavage were sampled in order to perform RT-PCR analyses for SARS-CoV-2-RNA, which all gave negative results. Autopsy showed coronary atherosclerosis, without acute complication. Microscopic examination of the heart revealed the existence of an intense multifocal inflammatory infiltration, in both ventricles and septum, composed in its majority of macrophages and CD8+ cytotoxic T lymphocytes (CD4/CD8 ratio: 0.11). Immunohistochemistry for anti-SARS nucleocapsid protein antibody was strongly positive in myocardial cells, but not in lung tissue. RT-PCR was realized on formalin-fixed paraffin-embedded lung and heart tissue blocks: only heart tissue was positive for SARS-CoV-2 RNA. In conclusion, this exhaustive post-mortem pathological case study of fulminant myocarditis demonstrates the presence of SARS-CoV-2 RNA in heart tissue, without significant lung involvement. Immunohistochemistry showed that the virus was specifically localized in cardiomyocytes and induced a strong cytotoxic T cells inflammatory response. This case report thus gives new insight in the pathogenesis of SARS-CoV-2-induced myocarditis and emphasizes on the importance and reliability of post-mortem analyses in order to better understand the physiopathology of this worldwide spreading new viral disease.
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影响因子：
0.5
作者：
Dettmeyer, R.;Lasczkowski, G.;Kernbach-Wighton, G.
通讯作者：
Kernbach-Wighton, G.
影响因子：
2.1
作者：
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通讯作者：
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作者：
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通讯作者：
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1
作者：
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通讯作者：
Plata-Mosquera, Carlos Andres
影响因子：
10.8
作者：
Bojkova, Denisa;Wagner, Julian U. G.;Dimmeler, Stefanie
通讯作者：
Dimmeler, Stefanie