Post-mortem of SARS-CoV-2 breakthrough infection

An 86-year-old male was transported to the Emergency Department of a hospital after a syncopal episode associated with abdominal pain and diarrhea.

He had multiple comorbidities (ischemic heart disease, diabetes, hypertension) and received two doses of BNT162b2 (Pfizer-BioNTech) mRNA vaccination (the last dose seven months before admission) and was fully vaccinated since the 3rd dose was not yet recommended. 

Laboratory tests at admission showed modest increase in C reactive protein and creatinine. CT documented two faint areas of ground glass opacity (GGO) in the left lower lobe and oropharyngeal swab tested positive for SARS-CoV-2 infection. Despite the appropriate treatment, the clinical condition of the patient did not improve, leading to his death about three weeks after the hospital admission.

Post-mortem CT (PMCT) also known as virtual autopsy is a non-invasive imaging autopsy appropriate for COVID-19 cases due to biohazard challenges. PMCT showed scant non-dependent on gravity areas of GGO, multiple areas of consolidations, and dependent on gravity densities. These findings were well-correlated with the previously reported imaging of the lungs in non-vaccinated individuals with early COVID-19 pneumonia and breakthrough SARS-COV-2 infections. At the forensic autopsy, all organs appeared swollen. The lungs appeared emphysematous at their apexes and congested at their bases. At the histopathological analysis, lungs showed congestion and edema, signs of intravascular coagulation and multinucleated giant cell with viral inclusions. According to the pathologists report, death was caused by an ischemic heart failure due to superinfected COVID-19 pneumonia and patient comorbidities. 


Filograna L, Manenti G, Grassi S, Zedda M, Cazzato F, Ryan CP, Arena V, Pascali VL, Colosimo C, Floris R, Oliva A. Virtual autopsy in SARS-CoV-2 breakthrough infection: a case report. Forensic Imaging. 2022 Sep 1;30:200520.


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