Histopathology of Middle East respiratory syndrome coronovirus (MERS-CoV) infection – clinicopathological and ultrastructural study

Aims The pathogenesis, viral localization and histopathological features of Middle East Respiratory Syndrome – Coronavirus (MERS-CoV) in human are not sufficiently described. The aims of this study were to explore and define the spectrum of histological and ultrastructural pathological changes affecting various organs in a patient with MERS-CoV infection and represent a base of MERS-CoV histopathology. Methods and results We analyzed the postmortem histopathological findings and investigated viral particles localization in the pulmonary and extra-pulmonary tissue by transmission electron microscopic examination in a 33-year-old male patient of T-cell lymphoma, who acquired MERS-CoV infection. Tissue needle biopsies were obtained from brain, heart, lung, liver, kidney and skeletal muscle. All samples were collected within 45 minutes from death to reduce tissue decomposition and artefact. Histopathological examination showed necrotizing pneumonia, pulmonary diffuse alveolar damage, acute kidney injury, portal and lobular hepatitis and myositis with muscle atrophic changes. The brain and heart were histologically unremarkable. Ultrastructurally, viral particles were localized in the pneumocytes, pulmonary macrophages, renal proximal tubular epithelial cells and macrophages infiltrating the skeletal muscles. Conclusion The results highlight the pulmonary and extra-pulmonary pathological changes of MERS-CoV infection and provide the first evidence of the viral presence in human renal tissue, which suggests tissue tropism for MERS-CoV in kidney. This article is protected by copyright. All rights reserved.