A clinicopathological study of three cases of severe acute respiratory syndrome (SARS).
OBJECTIVE
The severe acute respiratory syndrome (SARS) caused a large outbreak of atypical pneumonia in Beijing, China from early March 2003. We report the pathological features from three patients who died of SARS.


METHODS
Autopsies were performed on three patients who died 9-15 days after the onset of the illness, and the clinical and laboratory features reviewed. Tissue sections were stained with haematoxylin and eosin (H&E), and in situ reverse transcriptase polymerase chain reaction (RT-PCR) on lung sections was performed using SARS coronavirus-specific primers.


RESULTS
The typical gross pathological change in the lungs was diffuse haemorrhage on the lung surface. Histopathological examination revealed serous, fibrinous and haemorrhagic inflammation in most pulmonary alveoli, with capillary engorgement and some capillary microthrombosis. The pulmonary alveoli were thickened with interstitial mononuclear inflammatory infiltrates, diffuse alveolar damage, desquamation of pneumocytes and hyaline-membrane formation; fibrinoid material and erythrocytes were present in alveolar spaces. There were thromboemboli in some bronchial arterioles. Haemorrhagic necrosis and reduced numbers of lymphocytes were observed in lymph nodes and spleen. In situ RT-PCR detected SARS coronavirus RNA in type II alveolar cells, interstitial cells and bronchiolar epithelial cells from all three patients.


CONCLUSIONS
Severe immunological damage in lung tissue is responsible for the clinical features of SARS.
Lang
Zhen-Wei
ZW
Department of Pathology, Beijing Youan Hospital, Capital University of Medical Sciences, Beijing 100-054, China. langzw@21cn.com
Zhang
Li-Jie
LJ
Zhang
Shi-Jie
SJ
Meng
Xin
X
Li
Jun-Qiang
JQ
Song
Chen-Zhao
CZ
Sun
Ling
L
Zhou
Yu-Sen
YS
Dwyer
Dominic E
DE
D000368:Aged; D017931:DNA Primers; D005260:Female; D006801:Humans; D008168:Lung / Q000276:immunology / Q000473:pathology* / Q000821:virology*; D008198:Lymph Nodes / Q000276:immunology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D020133:Reverse Transcriptase Polymerase Chain Reaction; D045473:Severe acute respiratory syndrome-related coronavirus / Q000302:isolation & purification; D045169:Severe Acute Respiratory Syndrome / Q000276:immunology* / Q000473:pathology* / Q000821:virology; D013154:Spleen / Q000276:immunology / Q000473:pathology
D017931:DNA Primers