Department of Pathology and Neuropathology, University Hospital Tübingen and Eberhard Karls University Tübingen, Liebermeisterstraße 8, 72076, Tübingen, Germany.
Department of Internal Medicine I, University Hospital Tübingen, Tübingen, Germany.
Virchows Arch. 2020 Sep;477(3):349-357. doi: 10.1007/s00428-020-02881-x. Epub 2020 Jun 30.
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.
2019 年冠状病毒病（COVID-19）大流行已在全球范围内导致超过 35.5 万人死亡。然而，关于尸检结果的出版物却很少。我们展示了四起致命 COVID-19 病例的肺部发现，这些病例的肺部病理变化范围反映了疾病的过程和持续时间、侵袭性治疗和实验室特征。早期疾病的特征是中性粒细胞性、渗出性毛细血管炎，伴有微血栓形成和高水平的白细胞介素-1β和白细胞介素-6。后期与弥漫性肺泡损伤和中小肺血管内持续的血管内血栓形成有关，偶尔伴有梗死等价物区域，伴有弥漫性血管内凝血的实验室特征。在后期，可以观察到伴有广泛肺泡内成纤维细胞增殖和肺泡上皮明显化生的机化性肺炎。在肺中可以遇到病毒 RNA，在内皮细胞和肺泡细胞中有病毒颗粒。在许多患者中，最终会出现多器官衰竭和严重的肝损伤，这可能是由于早期炎症细胞因子风暴和/或血栓性微血管病。
