Cerebral Palsy, COVID-19, and Neurolipidosis in an 18-Year-Old Female

Since the novel coronavirus (COVID-19) pandemic started, children and young adults have seldom been placed in high-risk groups, despite reports that they are at increased risk of severe forms of the disease and death in the presence of comorbidities. Herein we report an autopsy case of an 18-year-old female with a history of cerebral palsy (CP), recurrent respiratory infections, and newly diagnosed COVID-19, and who expired 22 days after presenting with symptoms of the disease. Gross findings were concurrent with CP-significant hypotrophy, with deep and wide brain sulci. The lungs grossly were with increased weight and blood-filled. Histopathology of the respiratory system showed the well-established COVID-19-associated alveolar multinucleated cells, type two pneumocyte hyperplasia, and vascular changes. Furthermore, foci of groups of enlarged cells with foamy cytoplasm were identified in the pulmonary interstitium. Similar changes were also seen in the spleen, liver, and central nervous system, concurrent with an unrecognized lipid storage disease. The clinically unrecognized neurolipidosis, corresponding morphologically and clinically to Niemann-Pick disease type B, leading to interstitial lung disease and recurrent respiratory infections, inevitably played a role in the severity and progression of COVID-19 in our case, despite the age.