Case Report: PDF OnlyClinicopathologic Features of COVID-19 A Case Report and Value of Forensic Autopsy in Studying SARS-CoV-2 InfectionRen, Liang MD*; Liu, Qian MD*; Wang, Rongshuai MD†; Chen, Rong MD‡; Ao, Qilin MD§; Wang, Xi PhD∥; Zhang, Jie PhD*; Deng, Fei PhD∥; Feng, Yan MD¶; Wang, Guoping MD§; Zhou, Yiwu MD*; Li, Ling MD¶; Liu, Liang MD*Author Information From the *Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China †Hubei Chongxin Judicial Expertise Center, Wuhan 430415, Hubei, China ‡Department of Pathology, Wuhan Jin Yin-tan Hospital, Wuhan 430023, Hubei, China §Institute of Pathology/Department of Pathology, Tongji Hospital/Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China ∥Center for Biosafety Mega-Science and Technology, Wuhan Institute of Virology Chinese Academy of Sciences, Wuhan 430071, Hubei, China ¶Basic Medical Science and Forensic Medicine, Hangzhou Medical College, Hangzhou 310053, Zhejiang, China. Manuscript received August 28, 2020; accepted September 9, 2020. L.R., Q.L., R.W., G.W. contributed equally to this work. The authors report no conflict of interest. The compliance with Ethical Statement: This study was approved by the ethics committee of Tongji Medical College, Huazhong University of Science and Technology. Reprints: Liang Liu, MD, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan, Hubei 430030, China. E-mail: [email protected]; Yiwu Zhou, MD, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan, Hubei 430030, China. E-mail: [email protected]; Ling Li, MD, School of Basic Medical Science and Forensic Medicine, Hangzhou Medical College, 481 Binwen Rd, Hangzhou, Zhejiang 310053, China. E-mail: [email protected]. Funding: This work was supported by the Ministry of Science and Technology of P.R. of China [2020YFC0844700 to Liang L.] and the Department of Science and Technology, Hubei Provincial People's Government [2020FCA045 to Liang L, Q. L.] and in part by Medical Research Fund of Hangzhou Medical College This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections. The American Journal of Forensic Medicine and Pathology: January 15, 2021 - Volume Publish Ahead of Print - Issue - doi: 10.1097/PAF.0000000000000644 Buy PAP Metrics Abstract 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. © 2021 by Lippincott Williams & Wilkins.