Clinicopathologic Features of COVID-19: A Case Report and Value of Forensic Autopsy in Studying SARS-CoV-2 Infection

Am J Forensic Med Pathol. 2021 Jun 1;42(2):164-169. doi: 10.1097/PAF.0000000000000644.


As of August 23, 2020, the 2019 novel coronavirus disease (COVID-19) has infected more than 23,518,340 people and caused more than 810,492 deaths worldwide including 4,717 deaths in China. We present a case of a 53-year-old woman who was admitted to the hospital because of dry coughs and high fever on January 26, 2020, in Wuhan, China. She was not tested for SARS-CoV-2 RNA until on hospital day 11 (illness day 21) because of a significant shortage of test kits at the local hospital. Then, her test was positive for COVID-19 on hospital day 20. Despite intensive medical treatments, she developed respiratory failure with secondary bacterial infection and expired on hospital day 23 (3 days after she was tested positive for SARS-CoV-2 RNA). A systemic autopsy examination, including immunohistochemistry and ultrastructural studies, demonstrates that SARS-CoV-2 can infect multiple organs with profound adverse effect on the immune system, and the lung pathology is characterized by diffuse alveolar damage. Extrapulmonary SARS-CoV-2 RNA was detected in several organs postmortem. The detailed pathological features are described. In addition, this report highlights the value of forensic autopsy in studying SARS-CoV-2 infection and the importance of clinicopathological correlation in better understanding the pathogenesis of COVID-19.

Publication types

  • Case Reports

MeSH terms

  • Autopsy
  • COVID-19 / diagnosis*
  • Epiglottitis / pathology
  • Female
  • Fibroblasts / pathology
  • Humans
  • Infarction / pathology
  • Intracranial Thrombosis / pathology
  • Kidney / blood supply
  • Kidney / pathology
  • Lung / pathology
  • Lymph Nodes / pathology
  • Lymphocytes / pathology
  • Middle Aged
  • Myocytes, Cardiac / pathology
  • Myofibroblasts / pathology
  • Necrosis
  • RNA, Viral / analysis
  • Splenic Infarction / pathology
  • Subarachnoid Hemorrhage / pathology
  • Thromboembolism / pathology
  • Thrombosis / pathology
  • Thyroiditis, Autoimmune / pathology
  • Urinary Bladder / pathology


  • RNA, Viral