Faculty Collaboration Database

Diffuse interstitial pneumonia-like/macrophage activation syndrome-like changes in patients with COVID-19 correlate with length of illness. Ann Diagn Pathol 2021 Aug;53:151744

Date

05/16/2021

Pubmed ID

33991784

Pubmed Central ID

PMC8053602

DOI

10.1016/j.anndiagpath.2021.151744

Scopus ID

2-s2.0-85105597450 (requires institutional sign-in at Scopus site)   2 Citations

Abstract

OBJECTIVES: Assess the pathologic changes in the lungs of COVID-19 decedents and correlate these changes with demographic data, clinical course, therapies, and duration of illness.

METHODS: Lungs of 12 consecutive COVID-19 decedents consented for autopsy were evaluated for gross and histopathologic abnormalities. A complete Ghon "en block" dissection was performed on all cases; lung weights and gross characteristics recorded. Immunohistochemical studies were performed to characterize lymphocytic infiltrates and to assess SARS-CoV-2 capsid protein.

RESULTS: Two distinct patterns of pulmonary involvement were identified. Three of 12 cases demonstrated a predominance of acute alveolar damage (DAD) while 9 of 12 cases demonstrated a marked increase in intra-alveolar macrophages in a fashion resembling desquamative interstitial pneumonia or macrophage activation syndrome (DIP/MAS). Two patterns were correlated solely with a statistically significant difference in the duration of illness. The group exhibiting DAD had duration of illness of 5.7 days while the group with DIP/MAS had duration of illness of 21.5 days (t-test p = 0.014).

CONCLUSIONS: The pulmonary pathology of COVID-19 patients demonstrates a biphasic pattern, an acute phase demonstrating DAD changes while the patients with a more prolonged course exhibit a different pattern that resembles DIP/MAS-like pattern. The potential mechanisms and clinical significance are discussed.

Author List

Felix JC, Sheinin YM, Suster D, Ronen N, Ratiani M, Vanden Heuvel T, Winge E, Patton MD, Rau MJ, Ge L, Sun Y, Udhane SS, Langenheim JF, Rui H

Authors

Juan Felix MD Vice Chair, Director, Professor in the Pathology department at Medical College of Wisconsin
Yuri M. Sheinin MD, PhD Associate Professor in the Pathology department at Medical College of Wisconsin
Yunguang Sun MD, PhD Assistant Professor in the Pathology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Aged, 80 and over
Autopsy
Capsid Proteins
Comorbidity
Female
Humans
Immunohistochemistry
Lung
Lung Diseases, Interstitial
Lymphocytes
Macrophage Activation Syndrome
Macrophages
Male
Middle Aged
Pulmonary Alveoli
Sick Leave