We present results from clinical, radiologic, gas exchange, lung mechanics, and fibre-optic bronchoscopy-guided transbronchial biopsies in a case of acute respiratory failure due to SARS-CoV-2 (Covid-19). This report highlights the pulmonary, immunological, and inflammatory changes found during acute diffuse alveolar damage and the later organizing phase. An early diffuse alveolar damage pattern with predominant epithelial involvement with active recruitment of T cells and monocytes was observed followed by a late organizing pattern with pneumocyte hyperplasia, inflammatory infiltration, prominent endotheliitis, and secondary germinal centers. The patient’s deterioration paralleling the late immuno-pathological findings based the decision to administer intravenous corticosteroids, resulting in clinical, gasometric, and radiologic improvement. We believe that real-time clinicopathological correlation, along with the description of the immunological processes at play, will contribute to the full clinical picture of Covid-19 and might lead to a more rational approach in the precise timing of anti-inflammatory, anti-cytokine, or steroid therapies.

我们展示了 SARS-CoV-2 (Covid-19) 引起的急性呼吸衰竭病例的临床、放射学、气体交换、肺力学和纤维支气管镜引导下经支气管活检的结果。本报告重点介绍了在急性弥漫性肺泡损伤和后期组织阶段发现的肺部、免疫和炎症变化。观察到早期弥漫性肺泡损伤模式，主要是上皮受累，T 细胞和单核细胞活跃募集，随后是晚期组织模式，肺细胞增生、炎症浸润、显着内皮炎和继发性生发中心。患者的病情恶化与晚期免疫病理学检查结果一致，这是基于静脉注射皮质类固醇的决定，导致临床、气测和影像学改善。