These characteristics also resemble progression of HP with continued chronic exposure to antigen. Severe SARS-CoV-2 begins much like mild or moderate cases with symptoms such dyspnea and cough, but may progress into a pneumonia-like disease with progression toward respiratory failure and pulmonary thrombosis. Altogether, the favored course is to begin treatments that address the disease at the earliest phase before immune dysregulation leading to uncontrolled pulmonary inflammation.Ī recent opinion report from Seoul, Korea suggested that the main lethal complication of the severe acute respiratory syndrome that results from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral infection, also known as coronavirus Disease 2019 (COVID-19), is manifesting as a form of hypersensitivity pneumonitis (HP). We review similarities in disease presentation between infection and allergy, relevant immunopathology, and outline phases of SARS-CoV-2 disease with perspectives on therapy and critical care. Accordingly, the purpose of our letter is to shift the emphasis of concern surrounding immune activity from viral infection to an HP-like severe immune reaction.
We propose that the novel SARS-CoV-2 can act as a trigger and substrate of an HP-like severe immune reaction especially in genetically vulnerable individuals in addition to those with immune senescence and dysregulation. A review of recent Severe acute respiratory syndrome-related coronavirus (SARS-CoV) and SARS-CoV-2 medical reports, as well as described characteristics of HP, lead us to postulate a theory for SARS-CoV-2 severe disease.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the coronavirus responsible for our recent coronavirus disease 2019 pandemic, is driving a lung immunopathology that strongly resembles a severe form of hypersensitivity pneumonitis (HP). Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA.ĥIntensive & Critical Care Unit, Larkin Health System, South Miami, FL, USA.ĦZymo Research Corporation, Irvine, California, USA. Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA.ĤDepartment of Internal Medicine, Roy J. Rizvi, 1ġDivision of Clinical & Translational Research, Larkin Health System, South Miami, Florida, USA.ģInflammation Program, Roy J. Issuree, 3, 4 George Yatzkan, 5 Syed A. Sanchez-Gonzalez, 1 Dave Moskowitz, 2 Priya D. English.Ĭopyright © 2020 by The Korean Society of Infectious Diseases, Korean Society for Antimicrobial Therapy, and The Korean Society for AIDSĪ Pathophysiological Perspective on COVID-19's Lethal Complication: From Viremia to Hypersensitivity Pneumonitis-like Immune Dysregulation
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