Celen-Gellerstedt syndrome with the development of microhemorrhages in the lungs after reinfection with SARS-CoV-2

A rare case of fatal outcome in Celen–Gellerstedt syndrome with the development of microhemorrhages in the lungs after reinfection with SARS-CoV-2 is presented. The morphological changes in lung tissue and their correlation with clinical, laboratory, and instrumental study data are described. Multiple hemorrhages with areas of pneumonia were found in the lung tissue. The interalveolar septa exhibited fibrinoid disorganization, diffuse infiltration, and scattered multinucleated cells containing hemosiderin. A distinctive feature of this case is that the fatal outcome occurred at a young age, with no thickening of the alveoli, fibrosis of lung tissue, right heart hypertrophy, or somatic pathology, but with pronounced morphological changes in the form of fibrinoid disorganization of the vessel walls, diffuse cellular infiltration, and significant hemorrhagic exudate in the alveolar lumens. Multiple hemorrhages with an abundance of macrophages and hemosiderin granules were observed, and cells in the interalveolar septa showed karyolysis. Ruptures of small and medium-sized pulmonary vessels and small thrombi in some of them were noted. Thus, the hereditary insufficiency of elastic fibers in the small and medium-sized pulmonary vessels, characteristic of Celen–Gellerstedt syndrome, likely contributed to their dilation, increased permeability, blood stasis, ruptures, and hemorrhages in lung tissue. It is particularly noteworthy that small thrombotic masses were identified specifically in these vessels. The trigger was reinfection with SARS-CoV-2.