Case report: Histopatological findings in necropsy of a patient with fatal Crimean-Congo Hemorrhagic Fever in Iran

Crimean-Congo Hemorrhagic Fever (CCHF) is a potentially fatal viral disease. Humans usually acquire the illness through tick bite or from contact with infected blood or other tissues from patients or livestock. CCHF is reported from most parts of Asia, Africa and Europe. This illness was endemic in the eastern provinces of the Caspian sea and has been described in old Iranian medical references. Because of the low incidence, reports on histopathologic findings are relatively few and limited worldwide. In this study we review the necropsy findings of a 24-year old woman with fatal form of CCHF in whom the diagnosis was established with positive viral culture and positive ELISA and RT-PCR in WHO reference laboratory. In liver, hepatocyte necrosis without inflammatory cells in bone marrow, hyperplasia of all three cell lines with myeloid preponderance in lungs, polymorphonuclear infiltration in alveolar spaces and alveolar edema in kidneys, glomerular necrosis, interstitial edema and tubular necrosis, and in brain, generalized edema with degenerative and cystic changes were found. There was no pathologic finding in striated muscle samples with light microscopy. In brief, these findings are compatible with multi-organ failure. Because of many new cases of this disease in recent years in Iran, widespread research for evaluation of histopathological changes is needed in Iranian patients to assist physicians and pathologists towards prompt diagnosis.