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. 2004 Aug;45(2):119-24.
doi: 10.1111/j.1365-2559.2004.01926.x.

The spectrum of pathological changes in severe acute respiratory syndrome (SARS)

O Y Cheung  1 , J W M Chan, C K Ng, C K Koo
Affiliations

The spectrum of pathological changes in severe acute respiratory syndrome (SARS)

O Y Cheung et al. Histopathology. 2004 Aug.

Abstract

Aims: To analyse the lung pathology of severe acute respiratory syndrome (SARS) and correlate the findings with the time sequence of the disease.

Methods and results: Ten patients with a clinical diagnosis of SARS, and virological confirmation of SARS coronavirus infection were identified. Histology in most cases showed diffuse alveolar damage, from early to late phases, and the changes corresponded to the time sequence. Other variable features include multinucleated giant cells, pneumocytes with cytomegaly and variable amounts of inflammatory cells and foamy macrophages. One case showed superimposed bronchopneumonia. No viral inclusions were found. Coronavirus particles were identified in pneumocytes by electron microscopy.

Conclusions: The predominant pathological process of SARS is diffuse alveolar damage and, in patients who die from the disease, there is evidence of organization and fibrosis. There are apparently no histological features specific for this disease, and the aetiological diagnosis depends on virological and ultrastructural studies.

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Figures

Figure 1
Figure 1
Post mortem lung section from a patient who died on day 8 shows extensive hyaline membrane.
Figure 2
Figure 2
a , Post mortem lung section from a patient who died on day 20 shows air space organization in addition to alveolar fibrin and hyaline membrane. There is also a moderate lymphocytic infiltrate. b , Squamous metaplasia is also present.
Figure 3
Figure 3
Paramortem lung biopsy from a patient who died on day 46 shows marked fibrosis with distortion of normal alveolar and septal architecture.
Figure 4
Figure 4
Organizing diffuse alveolar damage with superimposed bronchopneumonia. There are abundant neutrophils in alveolar spaces.
Figure 5
Figure 5
Electron microscopy of the open lung biopsy shows intracytoplasmic viral particles within membrane‐bound vesicles (original magnification × 52 000). Inset: A spherical enveloped virion (diameter 88 nm) with spike‐like projections on the surface and clumps of electron dense material in the centre (original magnification × 73 000).
See this image and copyright information in PMC

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