COVID-19 is an acute respiratory viral disease caused by the new coronavirus SARS-CoV-2. The common complication of COVID-19 is acute respiratory distress syndrome. Other recorded complications include acute kidney and myocardial injuries and multiple organ failure. The paper describes a case of severe COVID-19 in a 68-year-old female inpatient diagnosed with severe bilateral community-acquired systemic pneumonia. She was admitted to hospital with complaints of weakness, a feeling of chest congestion, dyspnea, and a fever of up to 38.0°C. The concomitant diseases were diabetes mellitus, hypertension, and coronary heart disease. Despite the treatment, her condition progressively worsened and she died. Autopsy study revealed the clinical presentation of hemorrhagic pneumonia with alveolar fibrin areas, desquamation, necrotic alveolar epithelial areas, and edema with a hemorrhagic component. The image of the heart showed a picture of concentric hypertrophy: cardiomyocytes with large lobulated hyperchromatic nuclei were disconnected and isolated from each other by interstitial interlayers. The clinical presentations of diabetic microangiopathy, such as plasmorrhagia and vascular hyalinosis, were visualized. Necronephrosis was detected in the kidneys. Virological examination revealed viral RNA in COVID-19. In the described case, the lung clearly shows a tendency from the exudative to proliferative phase; however, hemorrhagic edema still prevailed due to a premorbid history (diabetes mellitus, hypertension, obesity, microangiopathy); this led to the development of acute pulmonary heart failure, lung and brain edema, and necronephrosis.

Keywords: necronephrosis, COVID-19, pneumonia, diabetes mellitus, obesity, hypertension