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Histopathological findings in fatal COVID-19 severe acute respiratory syndrome: preliminary experience from a series of 10 Spanish patients
  1. Borja Recalde-Zamacona1,2,
  2. Laura García-Tobar3,
  3. Alan Argueta3,
  4. Laura Álvarez3,
  5. Carlos Eduardo De Andrea3,
  6. Mirian Fernández Alonso4,
  7. Ana Ezponda5,
  8. Francisco Carmona Torre2,4,
  9. Carlota Jordán Iborra2,6,
  10. Jorge Augusto Quiroga2,6,7,
  11. Jose Luis Del Pozo2,4,
  12. Javier J Zulueta1,2,
  13. Gema Echarri8,
  14. Manuel F Landecho2,6,
  15. Maria Dolores Lozano3,9,10
  1. 1 Service of Pulmonary Medicine, Clinica Universitaria, Pamplona, Spain
  2. 2 Covid19 Department, Clinica UNiversidad de Navarra, Pamplona, Navarra, Spain
  3. 3 Pathology, University of Navarra, Pamplona, Navarra, Spain
  4. 4 Microbiology and infectious diseases, Clinica Universidad de Navarra, Pamplona, Spain
  5. 5 Radiology, Clinica Universitaria de Navarra, Pamplona, Spain
  6. 6 Internal Medicine, Clinica Universidad de Navarra, Pamplona, Spain
  7. 7 CIBEREHD, CIBER, Pamplona, Spain
  8. 8 Intensive Care Unit, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
  9. 9 Centro de Investigación Biomédica en Red, Madrid, Comunidad de Madrid, Spain
  10. 10 Instituto de Investigación Sanitaria de Navarra, Pamplona, Navarra, Spain
  1. Correspondence to Dr Manuel F Landecho, Clínica Universidad de Navarra, 31008 Pamplona, Navarra, Spain; mflandecho{at}


In December 2019, an outbreak of severe acute respiratory syndrome associated to SARS-CoV2 was reported in Wuhan, China. To date, little is known on histopathological findings in patients infected with the new SARS-CoV2. Lung histopathology shows features of acute and organising diffuse alveolar damage. Subtle cellular inflammatory infiltrate has been found in line with the cytokine storm theory. Medium-size vessel thrombi were frequent, but capillary thrombi were not present. Despite the elevation of biochemical markers of cardiac injury, little histopathological damage could be confirmed. Viral RNA from paraffin sections was detected at least in one organ in 90% patients.

  • viral infection
  • ARDS
  • imaging/CT MRI etc
  • histology/cytology

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  • MFL and MDL contributed equally.

  • Correction notice This article has been corrected since it was published Online First. The first author's name has been amended.

  • Contributors BR has sampled all postmortem biopsy and written the manuscript. LG-T, AA, LA and CEDA have equally contributed on histopathological interpretation. JJZ and JAQ have reviewed the manuscript and done the english editing. AE radiology interpretation and images selection. MFL and FCT microbiology samples. JLDP, GE and CJI attended the patients and helped with postmortem biopsies. MFL and MDL designed the study and reviewed the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The ethics committee of the University of Navarra approved the publication of the case series.

  • Provenance and peer review Not commissioned; externally peer reviewed.