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10.1159/000525457

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suck abstract from ncbi


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pmid35835004      Pathobiology 2023 ; 90 (2): 138-146
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  • Interstitial Pulmonary Fibrosis and Extensive Dendriform Ossification with Persistent Viral Load: A Rare Presentation of Post-COVID-19 Condition in Need of Lung Transplantation #MMPMID35835004
  • Haslbauer JD; Bratic-Hench I; Cima K; Luger AK; Schmitz K; Augustin F; Krapf C; Hoefer D; Tancevski I; Tzankov A; Loffler-Ragg J
  • Pathobiology 2023[]; 90 (2): 138-146 PMID35835004show ga
  • The incidence, presentation, and predisposing factors of post-acute sequelae of COVID-19 (PASC) are currently poorly understood. Lung explants may provide a rare insight into terminal SARS-CoV-2-associated lung damage and its pathophysiology. A 62-year-old man presented with progressively worsening respiratory symptoms after recovering from mild COVID-19 3 months earlier. No underlying pulmonary comorbidities were reported. A chest CT revealed bilateral extensive ground-glass and reticular opacities, suspicious of pulmonary fibrosis. Despite initial high-dose glucocorticoid therapy, the interstitial lung disease progressed, and after exhausting all viable therapeutic options, bilateral lung transplantation was successfully conducted. Histological analysis revealed extensive end-stage interstitial fibrosis with diffuse dendriform ossification and bronchiolar and transitional cell metaplasia. Signs of interstitial remodeling such as an increased interstitial collagen deposition, a pathological accumulation of CD163+/CD206+ M2-polarized macrophages with an increased expression of phosphorylated ERK, and an increased density of CD105+ newly formed capillaries were observed. qRT-PCR and immunohistochemistry for SARS-CoV-2 N-protein in the endothelium of medium-sized vessels confirmed a persistence of SARS-CoV-2. Our findings highlight a highly unusual presentation of SARS-CoV-2-associated lung fibrosis, implying that incomplete viral clearance in the vascular compartment may play a vital pathophysiological role in the development of PASC.
  • |*Lung Diseases, Interstitial/diagnosis/surgery[MESH]
  • |*Lung/diagnostic imaging/pathology[MESH]
  • |*Osteogenesis[MESH]
  • |*Post-Acute COVID-19 Syndrome/complications[MESH]
  • |*Pulmonary Fibrosis[MESH]
  • |COVID-19/diagnosis[MESH]
  • |Disease Progression[MESH]
  • |Humans[MESH]
  • |Lung Transplantation[MESH]
  • |Male[MESH]
  • |Middle Aged[MESH]
  • |Treatment Outcome[MESH]


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