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ABSTRACT This brief communication demonstrates the correlation of persistent respiratory symptoms with functional, tomographic, and transbronchial pulmonary biopsy findings in patients with COVID-19 who had a long follow-up period. We report a series of six COVID-19 patients with pulmonary involvement who presented with persistent dyspnea within 4-15 months of discharge. We performed transbronchial biopsies, and the histopathological pattern consistently demonstrated peribronchial remodeling with interstitial pulmonary fibrosis. Therefore, lung biopsy may be useful in the approach of patients with long COVID-19, although the type of procedure, its precise indication, and the moment to perform it are yet to be clarified. (Brazilian Registry of Clinical Trials-ReBEC; identifier: RBR-8j9kqy [http://www.ensaiosclinicos.gov.br])
RESUMO Esta comunicação breve demonstra a correlação de sintomas respiratórios persistentes com achados funcionais, tomográficos e de biópsia pulmonar transbrônquica em pacientes com COVID-19 que tiveram um longo período de acompanhamento. Relatamos uma série de seis pacientes com COVID-19 com acometimento pulmonar que apresentavam dispneia persistente após 4-15 meses da alta. Realizamos biópsias transbrônquicas, e o padrão histopatológico consistentemente demonstrou remodelação peribrônquica com fibrose pulmonar intersticial. Portanto, a biópsia pulmonar pode ser útil na abordagem de pacientes com COVID-19 prolongada, embora o tipo de procedimento, suas indicações precisas e o momento de sua realização ainda não estejam esclarecidos. (Registro Brasileiro de Ensaios Clínicos - ReBEC; número de identificação: RBR-8j9kqy [http://www.ensaiosclinicos.gov.br])
RESUMO
Introducción: El objetivo del estudio es describir las características clínicas, patológicas, virológicas y genéticas de la respuesta inmune de los pacientes diagnosticados con infección por SARS-CoV-2 y su relación con el curso desfavorable de la enfermedad. Métodos: Estudio descriptivo, relacional, longitudinal y retrospectivo basado en la revisión de historias clínicas, toma de biopsias tru-cut post-mortem de pulmón e hígado, toma de muestras de sangre e hisopado naso-orofaríngeo o de aspirado del tubo endotraqueal. En la primera fase las biopsias serán procesadas y estudiada scon histología convencional e inmunohistoquímica en el servicio de Anatomía Patológica del hospital Nacional Carlos Seguín Escobedo de Arequipa, Perú. Resultados: La edad media avanzada, el sexo masculino y la presencia de comorbilidades fue predominante en los pacientes fallecidos. Las biopsias pulmonares mostraron predominante mente las fases exudativa y parcialmente proliferativa del daño alveolar difuso y focal, asociada principalmente a una hiperplasia de macrófagos intra alveolares con acumulación dentro del espacio alveolar, semejando una neumonía descamativa, así como neumocitos intra alveolares bi nucleados y atípicos, con nucléolos eosinofílicos (semejante avirocitos) en algunos casos. En la gran mayoría de casos se observaron depósitos de fibrina intravascular asociada al acúmulo de células inflamatorias compuestas por neutrófilos y monocitos, representando micro trombosis. Las biopsias de hígado mostraron esteatosis predominantemente macro vesicular y en dos casos se observó este atosismicro vesicular. Adicionalmente, se observaron diversos grados de necrosis e inflamación portal y lobular. Conclusión: Los hallazgos clínicos y patológicos en este primer reporte son consistentes con publicaciones previas y confirman el patrón de daño alveolar difuso asociado a agregados de macrofagos intra alveolares y micro trombosis; ademasesteatosis macro y micro vesicular hepatocitica, junto a grados variables de necrosis.
Introduction: The objective of the study is to describe the clinical, pathological, virological and genetic characteristics ofthe immune response of patients diagnosed with SARS-CoV-2 infection and its relationship with the unfavorable courseof the disease. Methods: Descriptive, relational, longitudinal and retrospective study based on the review of medicalrecords, taking post-mortem tru-cut biopsies of the lung and liver, taking blood samples and naso-oropharyngeal swabor endotracheal tube aspirate. In the first phase, the biopsies will be processed and studied with conventional andimmunohistochemical histology in the Pathological Anatomy service of the Carlos Seguín Escobedo National Hospitalin Arequipa, Peru. Results: Advanced mean age, male sex, and the presence of comorbidities were predominant indeceased patients. Lung biopsies showed predominantly the exudative and partially proliferative phases of diffuseand focal alveolar damage, associated primarily with intraalveolar macrophage hyperplasia with accumulation withinthe alveolar space-resembling desquamative pneumonia, as well as atypical binucleated intraalveolar pneumocytes,with eosinophilic nucleoli (similar to virocytes) in some cases. In the vast majority of cases, intravascular fibrin depositsassociated with the accumulation of inflammatory cells composed of neutrophils and monocytes, representingmicrothrombosis, were observed. Liver biopsies showed predominantly macrovesicular steatosis and in twocases microvesicular steatosis was observed. Additionally, varying degrees of necrosis and mild portal and lobularinflammation were observed. Conclusion: The clinical and pathological findings in this first report are consistent withprevious publications and confirm the pattern of diffuse alveolar damage associated with aggregates of intraalveolarmacrophages and microthrombosis; confirms in addition, macro and microvesicular hepatocytic steatosis, togetherwith variable degrees of necrosis.