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The evolution of pulmonary pathology in fatal COVID-19 disease: an autopsy study with clinical correlation
The pandemia of coronavirus disease 2019 (COVID-19) has caused more than 355,000 confirmed deaths worldwide. However, publications on postmortem findings are scarce. We present the pulmonary findings in four cases of fatal COVID-19 with a spectrum of lung pathology reflecting disease course and dura...
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| Published in: | Virchows Archiv : an international journal of pathology 2020-09, Vol.477 (3), p.349-357 |
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| container_issue | 3 |
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| container_title | Virchows Archiv : an international journal of pathology |
| container_volume | 477 |
| creator | Bösmüller, Hans Traxler, Selina Bitzer, Michael Häberle, Helene Raiser, Wolfgang Nann, Dominik Frauenfeld, Leonie Vogelsberg, Antonio Klingel, Karin Fend, Falko |
| description | The pandemia of coronavirus disease 2019 (COVID-19) has caused more than 355,000 confirmed deaths worldwide. However, publications on postmortem findings are scarce. We present the pulmonary findings in four cases of fatal COVID-19 with a spectrum of lung pathology reflecting disease course and duration, invasive therapies, and laboratory features. Early disease is characterized by neutrophilic, exudative capillaritis with microthrombosis and high levels of IL-1beta and IL-6. Later stages are associated with diffuse alveolar damage and ongoing intravascular thrombosis in small to medium-sized pulmonary vessels, occasionally with areas of infarction equivalents, accompanied by laboratory features of disseminated intravascular coagulation. In late stages, organizing pneumonia with extensive intra-alveolar proliferation of fibroblasts and marked metaplasia of alveolar epithelium can be observed. Viral RNA is encountered in the lung, with virus particles in endothelial cells and pneumocytes. In many patients, multi-organ failure with severe liver damage sets in finally, possibly as consequence of an early-onset pro-inflammatory cytokine storm and/or thrombotic microangiopathy. |
| doi_str_mv | 10.1007/s00428-020-02881-x |
| format | article |
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However, publications on postmortem findings are scarce. We present the pulmonary findings in four cases of fatal COVID-19 with a spectrum of lung pathology reflecting disease course and duration, invasive therapies, and laboratory features. Early disease is characterized by neutrophilic, exudative capillaritis with microthrombosis and high levels of IL-1beta and IL-6. Later stages are associated with diffuse alveolar damage and ongoing intravascular thrombosis in small to medium-sized pulmonary vessels, occasionally with areas of infarction equivalents, accompanied by laboratory features of disseminated intravascular coagulation. In late stages, organizing pneumonia with extensive intra-alveolar proliferation of fibroblasts and marked metaplasia of alveolar epithelium can be observed. Viral RNA is encountered in the lung, with virus particles in endothelial cells and pneumocytes. In many patients, multi-organ failure with severe liver damage sets in finally, possibly as consequence of an early-onset pro-inflammatory cytokine storm and/or thrombotic microangiopathy.</description><identifier>ISSN: 0945-6317</identifier><identifier>ISSN: 1432-2307</identifier><identifier>EISSN: 1432-2307</identifier><identifier>DOI: 10.1007/s00428-020-02881-x</identifier><identifier>PMID: 32607684</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Age ; Aged ; Alveoli ; Autopsies ; Autopsy ; Betacoronavirus ; Coagulation ; Coronavirus Infections - pathology ; Coronaviruses ; Correlation analysis ; COVID-19 ; Cytokine storm ; Cytokines ; Damage ; Disseminated intravascular coagulation ; Endothelial cells ; Epithelium ; Exudation ; Female ; Fibroblasts ; Humans ; IL-1β ; Infarction ; Inflammation ; Interleukin 1 ; Interleukin 6 ; Laboratories ; Leukocytes (neutrophilic) ; Liver diseases ; Lung diseases ; Lung Diseases - pathology ; Lung Diseases - virology ; Lungs ; Male ; Medicine ; Medicine & Public Health ; Metaplasia ; Middle Aged ; Original ; Original Article ; Pandemics ; Pathology ; Pneumocytes ; Pneumonia, Viral - pathology ; Quality in Pathology ; Ribonucleic acid ; RNA ; SARS-CoV-2 ; Thromboembolism ; Thrombosis ; Thrombosis - pathology ; Thrombosis - virology ; Thrombotic microangiopathy ; Viral diseases ; Viruses</subject><ispartof>Virchows Archiv : an international journal of pathology, 2020-09, Vol.477 (3), p.349-357</ispartof><rights>The Author(s) 2020</rights><rights>The Author(s) 2020. 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However, publications on postmortem findings are scarce. We present the pulmonary findings in four cases of fatal COVID-19 with a spectrum of lung pathology reflecting disease course and duration, invasive therapies, and laboratory features. Early disease is characterized by neutrophilic, exudative capillaritis with microthrombosis and high levels of IL-1beta and IL-6. Later stages are associated with diffuse alveolar damage and ongoing intravascular thrombosis in small to medium-sized pulmonary vessels, occasionally with areas of infarction equivalents, accompanied by laboratory features of disseminated intravascular coagulation. In late stages, organizing pneumonia with extensive intra-alveolar proliferation of fibroblasts and marked metaplasia of alveolar epithelium can be observed. Viral RNA is encountered in the lung, with virus particles in endothelial cells and pneumocytes. 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However, publications on postmortem findings are scarce. We present the pulmonary findings in four cases of fatal COVID-19 with a spectrum of lung pathology reflecting disease course and duration, invasive therapies, and laboratory features. Early disease is characterized by neutrophilic, exudative capillaritis with microthrombosis and high levels of IL-1beta and IL-6. Later stages are associated with diffuse alveolar damage and ongoing intravascular thrombosis in small to medium-sized pulmonary vessels, occasionally with areas of infarction equivalents, accompanied by laboratory features of disseminated intravascular coagulation. In late stages, organizing pneumonia with extensive intra-alveolar proliferation of fibroblasts and marked metaplasia of alveolar epithelium can be observed. Viral RNA is encountered in the lung, with virus particles in endothelial cells and pneumocytes. 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| language | eng |
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| source | Springer Nature |
| subjects | Age Aged Alveoli Autopsies Autopsy Betacoronavirus Coagulation Coronavirus Infections - pathology Coronaviruses Correlation analysis COVID-19 Cytokine storm Cytokines Damage Disseminated intravascular coagulation Endothelial cells Epithelium Exudation Female Fibroblasts Humans IL-1β Infarction Inflammation Interleukin 1 Interleukin 6 Laboratories Leukocytes (neutrophilic) Liver diseases Lung diseases Lung Diseases - pathology Lung Diseases - virology Lungs Male Medicine Medicine & Public Health Metaplasia Middle Aged Original Original Article Pandemics Pathology Pneumocytes Pneumonia, Viral - pathology Quality in Pathology Ribonucleic acid RNA SARS-CoV-2 Thromboembolism Thrombosis Thrombosis - pathology Thrombosis - virology Thrombotic microangiopathy Viral diseases Viruses |
| title | The evolution of pulmonary pathology in fatal COVID-19 disease: an autopsy study with clinical correlation |
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