COVID-19 postmortem: disseminated, diffuse alveolar damage predominates

  • Schaller T & al.
  • JAMA
  • 21 May 2020

  • curated by Liz Scherer
  • Clinical Essentials
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Takeaway

  • Postmortem COVID-19 findings confirm the role of acute and organizing diffuse alveolar damage.
  • SARS-CoV-2 genetic material is also detectable in the respiratory tract postmortem.

Why this matters

  • The primary cause of COVID-19-related death is acute respiratory distress syndrome because of diffuse alveolar damage in all lobes.

Key results

  • Postmortem examinations performed in 10 patients.
  • Median age: 79 (range, 64-90) years; 70% (7) male.
  • Median time from admission to death: 7.5 (range, 1-26) days.
  • Majority had median 4 (range, 0-6) known preexisting comorbidities. 
  • Major histologic finding: disseminated diffuse alveolar damage, detectable in all lobes (unevenly distributed in middle, lower lungs).
  • Consistent signs of exudative early-phase acute diffuse alveolar damage with hyaline membrane formation, intra-alveolar edema, thickened alveolar septa with perivascular lymphocyte-plasmocytic infiltration.
  • Reactive osseous, squamous metaplasia observed in areas of organizing diffuse alveolar damage.
  • Other:
    • Mild lymphocytic myocarditis in 4 and epicarditis in 2.
    • Nonspecific inflammation; no central nervous system involvement.
  • SARS-CoV-2 genetic material was detectable by PCR in the respiratory tract but not in cerebrospinal fluid.

Study design

  • Serial postmortem examinations of German patients with proven severe respiratory syndrome SARS-CoV-2 infection.
  • Funding: None disclosed.

Limitations

  • Small case numbers.
  • No proof of direct viral organ infection.