RT Journal Article
SR Electronic
T1 Clinical, radiological and pathological findings in patients with persistent lung disease following SARS-CoV-2 infection
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 2102411
DO 10.1183/13993003.02411-2021
VO 60
IS 4
A1 Claudia Ravaglia
A1 Claudio Doglioni
A1 Marco Chilosi
A1 Sara Piciucchi
A1 Alessandra Dubini
A1 Giulio Rossi
A1 Federica Pedica
A1 Silvia Puglisi
A1 Luca Donati
A1 Sara Tomassetti
A1 Venerino Poletti
YR 2022
UL http://erj.ersjournals.com/content/60/4/2102411.abstract
AB Some patients experience pulmonary sequelae after SARS-CoV-2 infection, ranging from self-limited abnormalities to major lung diseases. Morphological analysis of lung tissue may help our understanding of pathogenic mechanisms and help to provide consistent personalised management. The aim of this study was to ascertain morphological and immunomolecular features of lung tissue. Transbronchial lung cryobiopsy was carried out in patients with persistent symptoms and computed tomography suggestive of residual lung disease after recovery from SARS-CoV-2 infection. 164 patients were referred for suspected pulmonary sequelae after COVID-19; 10 patients with >5% parenchymal lung disease underwent lung biopsy. The histological pattern of lung disease was not homogeneous and three different case clusters could be identified, which was mirrored by their clinical and radiological features. Cluster 1 (“chronic fibrosing”) was characterised by post-infection progression of pre-existing interstitial pneumonias. Cluster 2 (“acute/subacute injury”) was characterised by different types and grades of lung injury, ranging from organising pneumonia and fibrosing nonspecific interstitial pneumonia to diffuse alveolar damage. Cluster 3 (“vascular changes”) was characterised by diffuse vascular increase, dilatation and distortion (capillaries and venules) within otherwise normal parenchyma. Clusters 2 and 3 had immunophenotypical changes similar to those observed in early/mild COVID-19 pneumonias (abnormal expression of STAT3 in hyperplastic pneumocytes and PD-L1, IDO and STAT3 in endothelial cells). This is the first study correlating histological/immunohistochemical patterns with clinical and radiological pictures of patients with post-COVID lung disease. Different phenotypes with potentially different underlying pathogenic mechanisms have been identified.Post-COVID lung disease is not a single entity, but includes different subtypes, each of them potentially requiring separate and different management https://bit.ly/3BJDeUF