Abstract
Objectives: Respiratory failure is the major cause of death in coronavirus disease 2019 (COVID-19). Autopsy-based reports describe diffuse alveolar damage (DAD), organizing pneumonia, and fibrotic change, but data on early pathologic changes and during progression of the disease are rare.
Methods: We prospectively enrolled three patients with COVID-19 and performed full clinical evaluation, including high-resolution computed tomography. We took transbronchial biopsy (TBB) specimens at different time points and autopsy tissue samples for histopathologic and ultrastructural evaluation after the patients’ death.
Results: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was confirmed by reverse transcription polymerase chain reaction and/or fluorescence in situ hybridization in all TBBs. Lung histology showed reactive pneumocytes and capillary congestion in one patient who died shortly after hospital admission with detectable virus in one of two lung autopsy samples. SARS-CoV-2 was detected in two of two autopsy samples from another patient with a fulminant course and very short latency between biopsy and autopsy, showing widespread organizing DAD. In a third patient with a prolonged course, autopsy samples showed extensive fibrosis without detectable virus.
Conclusions: We report the course of COVID-19 in paired biopsy specimens and autopsies, illustrating vascular, organizing, and fibrotic patterns of COVID-19-induced lung injury. Our results suggest an early spread of SARS-CoV-2 from the upper airways to the lung periphery with diminishing viral load during disease.
Keywords: ARDS; COVID-19; Diffuse alveolar damage; Lung fibrosis; Lung pathology; Organizing pneumonia; SARS-CoV-2.
【저자키워드】 COVID-19, ARDS, SARS-CoV-2., Diffuse alveolar damage, Lung fibrosis, Lung pathology, Organizing pneumonia, 【초록키워드】 coronavirus disease, severe acute respiratory syndrome coronavirus 2, SARS-CoV-2, Coronavirus disease 2019, ARDS, coronavirus, Respiratory failure, Pneumonia, lung, fibrosis, Lung injury, progression, severe acute respiratory syndrome Coronavirus, virus, Autopsy, Spread, Computed tomography, reverse transcription polymerase chain reaction, polymerase chain reaction, Viral, Viral load, clinical evaluation, Patient, death, Fluorescence, Diffuse alveolar damage, Lung fibrosis, Hospital admission, reverse transcription, latency, respiratory, upper airway, cause of death, histology, disease, change, In situ hybridization, Lung pathology, Organizing pneumonia, High-resolution, biopsy, DAD, Autopsies, Chain Reaction, alveolar damage, upper airways, acute respiratory syndrome, Vascular, acute respiratory syndrome coronavirus, different time points, one patient, specimen, diffuse, alveolar, widespread, reactive, COVID-19-induced lung injury, polymerase chain, Course, enrolled, performed, died, pathologic, the patient, detectable, the disease, tissue sample, pneumocyte, different time point, patients with COVID-19, TBB, transbronchial, 【제목키워드】 SARS-CoV-2, Postmortem, finding, Sample, Antemortem, Confirmed,