- 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.
- 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.
- 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.
- Serial postmortem examinations of German patients with proven severe respiratory syndrome SARS-CoV-2 infection.
- Funding: None disclosed.
- Small case numbers.
- No proof of direct viral organ infection.