Clinicopathologic and Immunohistochemical Findings from Autopsy of Patient with COVID-19, Japan

C oronavirus disease (COVID-19), which was first reported in December 2019 in Wuhan, China, has been spreading rapidly and on a global scale.The causative virus is severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (1).The World Health Organization declared the outbreak of COVID-19 to be pandemic on March 11, 2020, and had reported 693,282 laboratory-confirmed cases and 33,106 deaths globally as of March 30 (2).Numerous studies of the clinical features of COVID-19 and the virologic characteristics of SARS-CoV-2 have been conducted in China to date (3,4).Postmortem examination will provide valuable information required to elucidate the pathogenesis of COVID-19; however, only 2 studies have been published on COVID-19 pathology thus far (5,6).Further, the distribution of SARS-CoV-2 in a patient and identification of which cells are infected by SARS-CoV-2 have yet to be reported.We describe the clinical course and the pathologic and virologic findings upon autopsy of a passenger on a cruise ship who died from COVID-19.The ship departed the port of Yokohama, Japan, on January 20, 2020, with a total of 3,711 passengers and crew; 712 (19%) of the persons on board were laboratory confirmed as having COVID-19.Of those, 12 had died as of March 31 (7). Case ReportThe passenger, an 84-year-old woman from Japan who had no notable medical history, had onset of fever (38.8°C) on February 5, followed by diarrhea (Table 1).On February 9, she went to the ship's medical office with shortness of breath, and a throat swab sample was taken.Three days later (illness day 8), she was admitted to Toshima Hospital (Tokyo, Japan) with dyspnea on exertion; body temperature was 38.2°C, pulse rate 70 beats/min, blood pressure 156/80 mm Hg, respiratory rate 16 breaths/min, and oxygen saturation 95% (with 2 L/min oxygen supplementation).A chest radiograph showed opacities in both lungs, and a computed tomography scan revealed ground glass opacities and consolidations, mainly in bilateral lower lung lobes (Figure 1, panels A-C).The diagnosis of COVID-19 was confirmed by real-time reverse transcription PCR on the throat swab and reported on illness day 9. On illness day 10, hypoxia progressed, even with 15 L/min oxygen supplementation.The patient expressly stated that she did not want mechanical ventilation.Ampicillin/ sulbactam was administered intravenously, based on the identification of Klebsiella pneumoniae and methicillin-sensitive Staphylococcus aureus by sputum culture.Corticosteroids were added after the appearance of progressive hypoxemia and acute respiratory distress syndrome.On illness day 13, the antiretroviral Clinicopathologic and Immunohistochemical Findings from Autopsy of Patient with COVID-19, Japan