Abstract
Pulmonary microthrombosis and vasculitis occur in fatal coronavirus disease 2019. To determine whether these processes occur in other life-threatening respiratory virus infections, we identified autopsy studies of fatal influenza (n = 455 patients), severe acute respiratory syndrome ([SARS] n = 37), Middle East respiratory syndrome (n = 2), adenovirus (n = 34), and respiratory syncytial virus (n = 30). Histological evidence of thrombosis was frequently present in adults with fatal influenza and SARS, with vasculitis also reported.
Highlights
We reviewed human autopsy data from other life-threatening respiratory virus infections to determine whether thrombosis and pulmonary vasculitis occur in other viral infections
From 1224 search results, we identified reports for patients with fatal influenza (n = 455 patients; 24 studies), severe acute respiratory syndrome ([SARS] n = 37; 4 studies), Middle East respiratory syndrome ([MERS] n = 2; 2 studies), adenovirus infection (n = 34; 9 studies), and respiratory syncytial virus (RSV) infection (n = 30; 5 studies)
Diffuse alveolar damage was reported in every study and present in 75% of patients
Summary
Pulmonary microthrombi are frequent autopsy findings in fatal COVID-19, even in the absence of macrovascular PTE, and in a subgroup of patients are likely due to immunothrombosis distinct from conventional PTE [2]. This occurs irrespective of receipt of LMWH thromboembolism prophylaxis [2]. There is mounting evidence of a spectrum of pulmonary vasculitis in COVID-19: neutrophilic capillaritis [3, 4], lymphocytic endotheliitis [5], lymphocyte-plasma cellular arterial vasculitis [6], obliterating endarteritis involving C5aR1+ macrophages [7 and MRP8+ mononuclear cell vasculitis [2] These findings, taken together, suggest that pulmonary vasculitis
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