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. Electronic supplementary material The online version of this article (10.1007/s00428-020-02881-x) contains supplementary material, which is available to authorized users.
【저자키워드】 COVID-19, lung, Autopsy, Microthrombosis, Capillaritis, 【초록키워드】 coronavirus disease, thrombosis, IL-6, RNA, Pandemia, death, Diffuse alveolar damage, disease, patients, Lung pathology, Organizing pneumonia, Disseminated intravascular coagulation, Endothelial cell, Liver damage, Pneumocytes, Laboratory features, Infarction, proliferation, IL-1beta, supplementary material, stages, disease course, Stage, thrombotic, multi-organ failure, early-onset, vessels, fatal COVID-19, neutrophilic, alveolar epithelium, fibroblast, pro-inflammatory cytokine storm, caused, characterized, virus particle, accompanied, intra-alveolar, invasive therapies, laboratory feature, 【제목키워드】 Evolution, correlation, Pulmonary pathology, fatal COVID-19, autopsy study,