Gross and Histopathology of COVID-19 With First Histology Report of Olfactory Bulb Changes

George S Stoyanov, Lilyana Petkova, Deyan L Dzhenkov, Nikolay R Sapundzhiev, Iliyan Todorov, George S Stoyanov, Lilyana Petkova, Deyan L Dzhenkov, Nikolay R Sapundzhiev, Iliyan Todorov

Abstract

In nearly a year since the first reported cases of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a lot has been established about the virus. Correlates in regards to the biology and cellular effects of SARS-CoV-2 have brought a lot of explanations to the clinical manifestations of the disease and possible therapeutic modalities. However, despite the discoveries made, the tropism of SARS-CoV-2 has not yet been fully established, nor have all the clinical aspects of COVID-19. Herein we report the gross and histological findings in two diseased patients. Apart from the already established pulmonary and vascular changes caused by SARS-CoV-2, we report the presence of histological changes of the olfactory bulbs and frontal lobes of the brain, which may present as a correlate for COVID-19 related anosmia. The olfactory bulbs histologically showed necrotizing olfactory bulbitis. As both the olfactory bulb and frontal lobe of the cerebrum are key areas of olfaction, we believe that this tropism of SARS-CoV-2 may be key to the development of anosmia and not changes within the nasal cavity.

Keywords: anosmia; autopsy; covid-19; olfactory bulbitis; pathology; pneumonia.

Conflict of interest statement

The author would like to disclose, that one of the authors (George Stoyanov, MD) as of the time of the submission of the manuscript is a member of the editorial approval board of the journal (Cureus Journal of Medical Sciences). The authors affirm that this in no way, shape, or form resulted in manipulation of the reviewer selection process, reviews themselves, or the initial of the final editorial decision.

Copyright © 2020, Stoyanov et al.

Figures

Figure 1. COVID-19 pulmonary histopathology.
Figure 1. COVID-19 pulmonary histopathology.
A: thick hyaline membranes (arrow), H&E stain, original magnification 400x; B: hemorrhagic areas (arrows), H&E stain, original magnification 20x; C: type II pneumocyte hyperplasia and syncytial cells (white arrows), and casts of desquamated respiratory epithelium (black arrow) in the alveoli, H&E stain, original magnification 400x; D: viral cytopathic effect with multinucleated cells (white arrow) and giant mononucleated cells (black arrows), H&E stain, original magnification 400x; E: perivascular multinucleated cells (arrow), H&E stain, original magnification 400x; F: endotheliitis - reactive endothelial cells (white arrows) and areas of endothelial desquamation (black arrow), H&E stain, original magnification 400x; G: focal fibroblast proliferation and alveolar space obliteration - organizing pneumonia (arrow), H&E stain, original magnification 100x; H: degenerative and necrotic changes in peripheral arterioles (arrows), H&E stain, original magnification 400. H&E: hematoxylin and eosin.
Figure 2. Pulmonary IHC.
Figure 2. Pulmonary IHC.
A: CD3 marking for T lymphocytes, original magnification 200x; B: CD20 marking for B lymphocytes, original magnification 200x; C: CD68 marking for macrophages, reaction in mono and multinucleated cells in the alveolar spaces, original magnification 400x; D: CD68 marking for macrophages, reaction in mono and multinucleated cells in the perivascular connective tissue, original magnification 400x. IHC: immunohistochemistry; CD: cluster of differentiation.
Figure 3. Necrotizing olfactory bulbitis as observed…
Figure 3. Necrotizing olfactory bulbitis as observed in both cases.
A and C: severe edema (white arrows) and diffuse inflammatory cell infiltration (black arrows), H&E stain, original magnification 100x; B and D: diffuse degenerative changes, H&E stain, original magnification 400x. H&E: hematoxylin and eosin.
Figure 4. Central nervous system histopathology.
Figure 4. Central nervous system histopathology.
A: inflammatory cell cuffs around small blood vessels (arrow), H&E stain, original magnification 400x; B: neuronophagia - inflammatory cells surrounding degenerative neurons (arrows), H&E stain, original magnification 400x; C: Cowrdy type A body (white arrow) and degenerative neuron with neuronophagia (black arrow), H&E stain, original magnification 400x; D: serous meningitis with focal inflammatory cell infiltration (white arrows) and focal hemorrhages (black arrow), H&E stain, original magnification 100x; E: subarachnoid hemorrhage (arrow) in the posterior fossa, H&E stain, original magnification 100x. H&E: hematoxylin and eosin.
Figure 5. Renal histopathology.
Figure 5. Renal histopathology.
A: lymphoplasmacytic inflammatory infiltration (white arrows) surrounding a small blood vessel with fibrinoid necrosis (black arrow), H&E stain, original magnification 200x; B: medium-sized blood vessel with fibrinoid necrosis, H&E stain, original magnification 200x. H&E: hematoxylin and eosin.

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