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Severe Fever With Thrombocytopenia Syndrome: An Autopsy-Proven Case With Radiologic-Pathologic Correlation
Haruka Sato1, Fumito Okada2, Ryuichi Takenaka3
1Department of Radiology, Oita University Faculty of Medicine.
Journal of Thoracic Imaging
|August 10, 2026
Summary
Severe fever with thrombocytopenia syndrome (SFTS), a tick-borne illness, can cause fatal lung injury. This autopsy case reveals key CT findings and highlights the role of cytokine storm in pulmonary hemorrhage.
Area of Science:
- Infectious Diseases
- Pulmonology
- Radiology
Background:
- Severe fever with thrombocytopenia syndrome (SFTS) is an emerging tick-borne viral infection with high mortality.
- Pulmonary involvement in SFTS is known, but radiologic-pathologic correlation is poorly understood.
Purpose of the Study:
- To correlate radiologic findings with pathological findings in a fatal case of SFTS with pulmonary involvement.
- To elucidate the role of cytokine storm and hemophagocytic syndrome in SFTS-related lung injury.
Main Methods:
- Autopsy-proven case report of a 79-year-old male with SFTS and pre-existing interstitial lung disease.
- Serial chest computed tomography (CT) imaging.
- Autopsy and histopathological examination including immunohistochemical staining for SFTS virus.
Main Results:
- CT showed progressive peripheral ground-glass opacities evolving to extensive bilateral consolidation, suggestive of pulmonary hemorrhage.
- Autopsy revealed diffuse pulmonary hemorrhage, alveolar damage, and numerous SFTS virus-infected cells.
- Histopathology confirmed diffuse alveolar damage with hyaline membranes and hemophagocytosis.
Conclusions:
- This case highlights CT findings of pulmonary involvement in fatal SFTS, demonstrating direct radiologic-pathologic correlation.
- Cytokine storm and hemophagocytic syndrome are critical in the pathogenesis of pulmonary hemorrhage and lung injury in SFTS.