title: Histopathological findings in a critically ill patient with avian influenza A (H7N9).
abstract: To date, data regarding the pulmonary histopathology of human H7N9 disease are scarce. We herein describe a patient with a severe case of avian influenza A (H7N9). A chest computerized tomography (CT) scan showed diffuse ground-glass opacities and consolidation throughout the lungs. A resection of pulmonary bullae in the right middle lobe was performed by video-assisted thoracic surgery (VATS) based on the extracorporeal membrane oxygenation (ECMO) supportive technique on the 23(rd) day after the onset of symptoms because of a right pneumothorax persistent air leak. The histopathological findings of the resected lung tissue revealed pneumocyte hyperplasia and fibroproliferative changes along with diffuse alveolar damage. Bronchoalveolar lavage fluid (BALF) specimens for influenza A (H7N9) virus were continuously positive for more than three weeks, despite oseltamivir treatment, and continuous viral replication significantly prolonged the course of the disease. The patient's clinical status continuously deteriorated, with the development of refractory hypoxemia due to progressive and rapid lung fibrosis, which was confirmed by the final histological changes observed from a limited post-mortem biopsy of lung tissue. Pre-terminally, he developed multi-organ failure and died on the 39(th) day after symptom onset, despite corticosteroid treatment.
authors.affiliation: 1 Department of Respiratory Medicine, 2 Department of Pathology, 3 Department of Radiology, 4 Department of Thoracic Surgery, Fuzhou Pulmonary Hospital of Fu Jian, Educational Hospital of Fujian Medical University, Fuzhou 350008, China.
authors.forename: Jin-Bao
authors.initials: JB
authors.lastname: Huang
authors.affiliation: 1 Department of Respiratory Medicine, 2 Department of Pathology, 3 Department of Radiology, 4 Department of Thoracic Surgery, Fuzhou Pulmonary Hospital of Fu Jian, Educational Hospital of Fujian Medical University, Fuzhou 350008, China.
authors.forename: Hong-Yan
authors.initials: HY
authors.lastname: Li
authors.affiliation: 1 Department of Respiratory Medicine, 2 Department of Pathology, 3 Department of Radiology, 4 Department of Thoracic Surgery, Fuzhou Pulmonary Hospital of Fu Jian, Educational Hospital of Fujian Medical University, Fuzhou 350008, China.
authors.forename: Jia-Fu
authors.initials: JF
authors.lastname: Liu
authors.affiliation: 1 Department of Respiratory Medicine, 2 Department of Pathology, 3 Department of Radiology, 4 Department of Thoracic Surgery, Fuzhou Pulmonary Hospital of Fu Jian, Educational Hospital of Fujian Medical University, Fuzhou 350008, China.
authors.forename: Chang-Qing
authors.initials: CQ
authors.lastname: Lan
authors.affiliation: 1 Department of Respiratory Medicine, 2 Department of Pathology, 3 Department of Radiology, 4 Department of Thoracic Surgery, Fuzhou Pulmonary Hospital of Fu Jian, Educational Hospital of Fujian Medical University, Fuzhou 350008, China.
authors.forename: Qing-Hua
authors.initials: QH
authors.lastname: Lin
authors.affiliation: 1 Department of Respiratory Medicine, 2 Department of Pathology, 3 Department of Radiology, 4 Department of Thoracic Surgery, Fuzhou Pulmonary Hospital of Fu Jian, Educational Hospital of Fujian Medical University, Fuzhou 350008, China.
authors.forename: Shu-Xing
authors.initials: SX
authors.lastname: Chen
authors.affiliation: 1 Department of Respiratory Medicine, 2 Department of Pathology, 3 Department of Radiology, 4 Department of Thoracic Surgery, Fuzhou Pulmonary Hospital of Fu Jian, Educational Hospital of Fujian Medical University, Fuzhou 350008, China.
authors.forename: Hong-Ying
authors.initials: HY
authors.lastname: Zhang
authors.affiliation: 1 Department of Respiratory Medicine, 2 Department of Pathology, 3 Department of Radiology, 4 Department of Thoracic Surgery, Fuzhou Pulmonary Hospital of Fu Jian, Educational Hospital of Fujian Medical University, Fuzhou 350008, China.
authors.forename: Xin-Hang
authors.initials: XH
authors.lastname: Wang
authors.affiliation: 1 Department of Respiratory Medicine, 2 Department of Pathology, 3 Department of Radiology, 4 Department of Thoracic Surgery, Fuzhou Pulmonary Hospital of Fu Jian, Educational Hospital of Fujian Medical University, Fuzhou 350008, China.
authors.forename: Xu
authors.initials: X
authors.lastname: Lin
authors.affiliation: 1 Department of Respiratory Medicine, 2 Department of Pathology, 3 Department of Radiology, 4 Department of Thoracic Surgery, Fuzhou Pulmonary Hospital of Fu Jian, Educational Hospital of Fujian Medical University, Fuzhou 350008, China.
authors.forename: Jian-Guang
authors.initials: JG
authors.lastname: Pan
authors.affiliation: 1 Department of Respiratory Medicine, 2 Department of Pathology, 3 Department of Radiology, 4 Department of Thoracic Surgery, Fuzhou Pulmonary Hospital of Fu Jian, Educational Hospital of Fujian Medical University, Fuzhou 350008, China.
authors.forename: Heng
authors.initials: H
authors.lastname: Weng
keywords: H7N9; Influenza virus; avian; histopathology; oseltamivir; pneumonia