Early onset acute lymphocytic interstitial pneumonitis (ALIP) in COVID-19 pathophysiology: preliminary lung autopsy findings

Abstract

Sri Lanka is one of few countries which has performed post mortem examinations in deaths due to SARS CoV-2 virus (COVID-19) infection. At the office of the Judicial Medical Officer of National Institute of Infectious Diseases (NIID)/Infectious Disease Hospital (IDH) we have performed over sixty (60) post mortem examinations of deceased persons who were confirmed positive for COVID-19 by Real Time - Polymerase Chain reaction (RT-PCR) test performed before or after death. They included a majority of deaths due to natural causes and few deaths due to unnatural causes such as accidents, suicides and homicides. The first autopsy was performed on 04th of May 2020. We have observed acute lymphocytic interstitial pneumonitis (ALIP) as a potentially fatal complication in COVID-19 infection at the initial stages of lung involvement. This phenomenon of early onset ALIP has not been reported in the literature of COVID-19 lung pathophysiology to date. This is a narrative of our histological findings. Our attempt is to highlight the importance early onset ALIP as a pathological entity in COVID-19 lung involvement, which will enhance the clinicians to better understand the pathophysiology of this new illness and modify their treatment strategies.