COVID-19: Autopsy findings in six patients between 26 and 46 years of age

Greuel, Selina; Ihlow, Jana; Dragomir, Mihnea-Paul; Streit, Simon; Corman, Victor Max; Haberbosch, Linus; Winkler, David; Meinhardt, Jenny; Aschman, Tom; Schneider, Julia; Trotsyuk, Iryna; Kunze, Catarina Alisa; Maurer, Lukas; Radbruch, Helena; Heppner, Frank L.; Horst, David; Elezkurtaj, Sefer

Objectives Studies on the coronavirus disease 2019 (COVID-19) usually focus on middle aged and older adults. However, younger patients may present with severe COVID-19 and potentially fatal outcomes. For optimized, more specialized therapeutic regimens in this particular patient group, a better understanding of underlying pathomechanisms is of uttermost importance. Methods This study investigates relevant pre-existing medical conditions, clinical histories and autopsy findings, together with SARS-CoV-2-RNA, determined by qPCR, and laboratory data in six COVID-19 decedents at an age of 50 years or younger who were autopsied at the Charité University Hospital. Results From a total of 76 COVID-19 patients who underwent an autopsy at our institution, 6 (7.9%) were 50 years old or younger. Most COVID-19 decedents of younger age presented with pre-existing medical conditions prior to SARS-CoV-2 infection. These included overweight and obesity, arterial hypertension, asthma, obstructive sleep apnea as well as graft-versus-host disease following cancer and bone marrow transplantation. Furthermore, clinical histories and autopsy results revealed a disproportionally high prevalence of thromboembolism and ischemic organ damage in this patient cohort. Histopathology and laboratory results indicated coagulopathies, signs of immune dysregulation and liver damage. Conclusions In conclusion, pre-existing health conditions may increase the risk of severe and fatal COVID-19 in younger patients who may be especially prone to developing thromboembolic complications, immune dysregulation and liver damage.