
A 17-year-old female with a medical history of obesity presented with approximately 1 week of viral symptoms and acute-onset shortness of breath. A diagnostic work-up revealed SARS-CoV-2 infection with associated COVID-19 pneumonia. She was admitted to the ICU for mechanical ventilation and standard COVID-19 treatment. Her chest CT showed scattered foci of airway filling within areas of airspace disease in a patchy distribution. Despite two weeks of escalating support, the patient died from cardiorespiratory failure. Lung examination at autopsy showed thrombi in the pulmonary artery distribution and bronchial/bronchiolar casts. This case is the first report of airway fibrin cast obstruction in a patient with fatal severe COVID-19 pneumonia. Bronchial circulation dysfunction found in COVID-19 infection may play a role in bronchial cast formation because of SARS-CoV-2.
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