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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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Autores principales: Bösmüller, Hans, Traxler, Selina, Bitzer, Michael, Häberle, Helene, Raiser, Wolfgang, Nann, Dominik, Frauenfeld, Leonie, Vogelsberg, Antonio, Klingel, Karin, Fend, Falko
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7324489/
https://www.ncbi.nlm.nih.gov/pubmed/32607684
http://dx.doi.org/10.1007/s00428-020-02881-x
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author Bösmüller, Hans
Traxler, Selina
Bitzer, Michael
Häberle, Helene
Raiser, Wolfgang
Nann, Dominik
Frauenfeld, Leonie
Vogelsberg, Antonio
Klingel, Karin
Fend, Falko
author_facet Bösmüller, Hans
Traxler, Selina
Bitzer, Michael
Häberle, Helene
Raiser, Wolfgang
Nann, Dominik
Frauenfeld, Leonie
Vogelsberg, Antonio
Klingel, Karin
Fend, Falko
author_sort Bösmüller, Hans
collection PubMed
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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00428-020-02881-x) contains supplementary material, which is available to authorized users.
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spelling pubmed-73244892020-06-30 The evolution of pulmonary pathology in fatal COVID-19 disease: an autopsy study with clinical correlation Bösmüller, Hans Traxler, Selina Bitzer, Michael Häberle, Helene Raiser, Wolfgang Nann, Dominik Frauenfeld, Leonie Vogelsberg, Antonio Klingel, Karin Fend, Falko Virchows Arch Original Article 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. Springer Berlin Heidelberg 2020-06-30 2020 /pmc/articles/PMC7324489/ /pubmed/32607684 http://dx.doi.org/10.1007/s00428-020-02881-x Text en © The Author(s) 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
spellingShingle Original Article
Bösmüller, Hans
Traxler, Selina
Bitzer, Michael
Häberle, Helene
Raiser, Wolfgang
Nann, Dominik
Frauenfeld, Leonie
Vogelsberg, Antonio
Klingel, Karin
Fend, Falko
The evolution of pulmonary pathology in fatal COVID-19 disease: an autopsy study with clinical correlation
title The evolution of pulmonary pathology in fatal COVID-19 disease: an autopsy study with clinical correlation
title_full The evolution of pulmonary pathology in fatal COVID-19 disease: an autopsy study with clinical correlation
title_fullStr The evolution of pulmonary pathology in fatal COVID-19 disease: an autopsy study with clinical correlation
title_full_unstemmed The evolution of pulmonary pathology in fatal COVID-19 disease: an autopsy study with clinical correlation
title_short The evolution of pulmonary pathology in fatal COVID-19 disease: an autopsy study with clinical correlation
title_sort evolution of pulmonary pathology in fatal covid-19 disease: an autopsy study with clinical correlation
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7324489/
https://www.ncbi.nlm.nih.gov/pubmed/32607684
http://dx.doi.org/10.1007/s00428-020-02881-x
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