Skip to main navigation menu Skip to main content Skip to site footer
##common.pageHeaderLogo.altText##

Original article

Vol. 150 No. 2526 (2020)

Clinical course of COVID-19 pneumonia in a patient undergoing pneumonectomy and pathology findings during the incubation period

DOI
https://doi.org/10.4414/smw.2020.20302
Cite this as:
Swiss Med Wkly. 2020;150:w20302
Published
19.06.2020

Summary

BACKGROUND

The cause of coronavirus disease 2019 (COVID-19) is severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Clinical information about patients undergoing lung resection while infected with this virus and pathological information about early COVID-19 pneumonia are still scarce.

CASE PRESENTATION

A 69-year-old male patient underwent a right pneumonectomy for squamous cell lung carcinoma. Until the fourth postoperative day, the patient, who had minor radiological changes on chest x-ray, was asymptomatic. From this day, the COVID-19 test, which was performed after the appearance of symptoms such as fever and shortness of breath, lymphopenia and diffuse ground glass opacity in the left lung on computed tomography, was reported to be positive. The patient was given NIMV (non-invasive mechanical ventilation), and hydroxychloroquine, favipiravir and azithromycin in isolation intensive care, with the diagnosis of severe pneumonia. He was discharged on the 17th postoperative day with healing of the lung lesions. The pathology specimen of the patient, who was found to have been infected with SARS-CoV-2 before the day of surgery, was examined retrospectively. Irregular and severe pneumocyte hyperplasia, interstitial thickening, oedema, pronounced protein exudates, diffuse enlargement of the alveolar walls, macrophage infiltration and fibroblastic proliferation, which is an indicator of early organisation, were detected.

CONCLUSION

We believe that the clinical course and pathology findings obtained after right pneumonectomy in a patient with pre-symptomatic COVID-19 pneumonia will guide the diagnosis and treatment of patients infected with SARS-CoV-2.

References

  1. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497–506. doi:.https://doi.org/10.1016/S0140-6736(20)30183-5
  2. COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU). ArcGIS. Johns Hopkins University. Retrieved 2020 May 1.
  3. Chen T, Wu D, Chen H, Yan W, Yang D, Chen G, et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. BMJ. 2020;368:m1091. doi:.. Correction in: 2020;368:m1295. doi:https://doi.org/10.1136/bmj.m1091
  4. Ferdinand B, Shennib H. Postoperative pneumonia. Chest Surg Clin N Am. 1998;8(3):529–39, viii.
  5. Cai Y, Hao Z, Gao Y, Ping W, Wang Q, Peng S, et al. Coronavirus Disease 2019 in the Perioperative Period of Lung Resection: A Brief Report From a Single Thoracic Surgery Department in Wuhan, People’s Republic of China. J Thorac Oncol. 2020;15(6):1065–72. doi:. https://doi.org/10.1016/j.jtho.2020.04.003
  6. Tian S, Xiong Y, Liu H, Niu L, Guo J, Liao M, et al. Pathological study of the 2019 novel coronavirus disease (COVID-19) through postmortem core biopsies. Mod Pathol. 2020;33(6):1007–14. doi:.https://doi.org/10.1038/s41379-020-0536-x
  7. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. 2020;323(11):1061. doi:.https://doi.org/10.1001/jama.2020.1585
  8. Chan JF, Yuan S, Kok KH, To KK, Chu H, Yang J, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet. 2020;395(10223):514–23. doi:.https://doi.org/10.1016/S0140-6736(20)30154-9
  9. Tian S, Hu W, Niu L, Liu H, Xu H, Xiao SY. Pulmonary Pathology of Early-Phase 2019 Novel Coronavirus (COVID-19) Pneumonia in Two Patients With Lung Cancer. J Thorac Oncol. 2020;15(5):700–4. doi:.https://doi.org/10.1016/j.jtho.2020.02.010
  10. Xu Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med. 2020;8(4):420–2. doi:.https://doi.org/10.1016/S2213-2600(20)30076-X
  11. COVID-19 Erişkin Hasta Yönetimi ve Tedavisi. 2020. https://covid19.saglik.gov.tr/depo/tedavi/COVID19-Hasta_Yonetimi_ve_Tedavisi. pdf (Erişim Tarihi: 27.03.2020).
  12. Lauer SA, Grantz KH, Bi Q, Jones FK, Zheng Q, Meredith HR, et al. The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application. Ann Intern Med. 2020;172(9):577–82. doi:.https://doi.org/10.7326/M20-0504
  13. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507–13. Published online January 30, 2020. doi:.https://doi.org/10.1016/S0140-6736(20)30211-7
  14. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al.; China Medical Treatment Expert Group for Covid-19. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020;382(18):1708–20. doi:.https://doi.org/10.1056/NEJMoa2002032
  15. Hamming I, Timens W, Bulthuis ML, Lely AT, Navis G, van Goor H. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis. J Pathol. 2004;203(2):631–7. doi:.https://doi.org/10.1002/path.1570
  16. Xiao SY, Wu Y, Liu H. Evolving status of the 2019 novel coronavirus infection: Proposal of conventional serologic assays for disease diagnosis and infection monitoring. J Med Virol. 2020;92(5):464–7. doi:.https://doi.org/10.1002/jmv.25702
  17. Hu Z, Song C, Xu C, Jin G, Chen Y, Xu X, et al. Clinical characteristics of 24 asymptomatic infections with COVID-19 screened among close contacts in Nanjing, China. Sci China Life Sci. 2020;63(5):706–11. Published online March 4, 2020. doi:.https://doi.org/10.1007/s11427-020-1661-4
  18. World Health Organization. Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected. 2020, March 14. https://www.who.int/docs/defau lt-sourc e/coron aviru se/clinical-management -of-novel -cov.pdf?sfvrs n=bc7da 517_10&download=true
  19. Cascella M, Rajnik M, Cuomo A, Scott C, Dulebohn SC, Di Napoli R. Features, Evaluation and Treatment Coronavirus (COVID-19) [Updated 2020 Apr 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan.
  20. Wu F, Zhao S, Yu B, Chen YM, Wang W, Song ZG, et al. A new coronavirus associated with human respiratory disease in China. Nature. 2020;579(7798):265–9.. doi:.https://doi.org/10.1038/s41586-020-2008-3
  21. Epidemiology Working Group for NCIP Epidemic Response, Chinese Center for Disease Control and Prevention. [The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China]. Zhonghua Liu Xing Bing Xue Za Zhi. 2020;41(2):145–51. [Epub ahead of print]. doi:.https://doi.org/10.3760/cma.j.issn.0254-6450.2020.02.003
  22. Liang W, Guan W, Chen R, Wang W, Li J, Xu K, et al. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol. 2020;21(3):335–7. doi:.https://doi.org/10.1016/S1470-2045(20)30096-6
  23. Pambuccian SE. The COVID-19 pandemic: implications for the cytology laboratory. J Am Soc Cytopathol. 2020;9(3):202–11. doi:.https://doi.org/10.1016/j.jasc.2020.03.001
  24. Menter T, Haslbauer JD, Nienhold R, Savic S, Hopfer H, Deigendesch N, et al. Post-mortem examination of COVID19 patients reveals diffuse alveolar damage with severe capillary congestion and variegated findings of lungs and other organs suggesting vascular dysfunction. Histopathology. 2020:his.14134. Epub ahead of print. doi:.https://doi.org/10.1111/his.14134