The few pathological analyses of coronavirus disease (COVID-19) pneumonia to date, mostly from autopsy studies, report diffuse alveolar damage or acute fibrinous and organizing pneumonia (1–3). In contrast, computed tomographic (CT) imaging from numerous patients with COVID-19 includes features more consistent with organizing pneumonia (OP) (4, 5). A previously healthy 61-year-old woman presented with 3 weeks of dyspnea, cough, and fevers; a nasopharyngeal RT-PCR for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and common respiratory pathogens was negative. CT imaging on Day 3 of admission demonstrated peripheral and basilar patchy opacities with perilobular sparing, consistent with an OP pattern (Figures 1A and 1B and Video 1). The patient had no signs or symptoms of an underlying rheumatologic condition and took no medications. Two days later, transbronchial biopsies throughout the right lung peripherally revealed scattered fibromyxoid plugs within distal airspaces, indicative of a histologic OP pattern (Figure 1C). RT-PCR for SARS-CoV-2 returned positive by BAL; other BAL cultures were unremarkable. The patient was started on remdesivir and made a full clinical recovery. CT imaging 26 days after presentation showed minimal residual opacities (Figure 1D and Video 2). OP findings in this case may stem from tissue sampling later in a self-limited course of mild to moderate COVID-19. Confirmed radiographically and histologically, OP, as an active and sometimes aberrant lung repair process, may represent the evolution of COVID-19 in patients with mild to moderate disease.
Supplementary Material
Footnotes
Author Contributions: Conception and design: B.P.P., K.E.S., and H.H.G. Analysis and interpretation: B.P.P., K.E.S., H.S., H.B., G.J.B., and H.H.G. Drafting the manuscript for important intellectual content: B.P.P., K.E.S., H.S., H.B., G.J.B., and H.H.G.
The uncompressed videos are accessible from this article’s supplementary material page.
Originally Published in Press as DOI: 10.1164/rccm.202004-1278IM on July 1, 2020
Author disclosures are available with the text of this article at www.atsjournals.org.
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