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Autopsy practice is one of the most well-defined procedures in medicine, with strict safety instructions in place to protect medical personnel from infectious agents. However, for various reasons, these precautionary measures are often overlooked. Herein we report two autopsy cases of patients who died during the COVID-19 pandemic and the national state of emergency declared in Bulgaria. One patient was a 77-year-old female who had a medical history of a viral respiratory tract infection in February 2020 but had not undergone any test. She had multiple comorbidities including hypertension, cerebral and cardiovascular disease, and type 2 diabetes. The other patient was a 53-year-old female with morbid obesity with previous medical history of malignancy, hypertension, and type 2 diabetes. Both patients were tested for COVID-19 during the autopsy. Gross and histological findings in both patients showed respiratory tract viral infection with severe complications, incompatible with life. The first patient had serous desquamative tracheitis, hemorrhagic pneumonia, pericarditis, meningitis, and acute necrotizing encephalitis. The second patient had serous tracheitis, interstitial pneumonia, and diffuse alveolar damage and pneumocyte cytopathic effect, the alveolar septi had undergone a fibrotic change, with serous meningitis and non-necrotizing encephalitis also noted histologically. Autopsy-wise, it is always important, against the backdrop of an epidemic, to use full precautionary measures and exclude epidemic strands in cases where gross findings are suggestive of a viral infection.

Non-COVID-19 viral respiratory tract infection as causes of death amid the pandemic: a report of two autopsy cases and tips for safe practice