All patients presented extensive pathological alterations in the lungs; lungs were heavy, diffusely edematous and with variable degrees of hemorrhage. Diffuse alveolar damage (DAD) was present in most of the patients, but as previously described, there were three distinct patterns of pulmonary pathological changes [11, 12] : (i) four patients had classic exudative DAD, with alveolar and interstitial edema, hyaline membranes and reactive pneumocytes; (ii) one patient (esophagus neoplasm) had DAD and severe necrotizing bronchiolitis (NB) characterized by extensive necrosis of the bronchiolar wall and dense neutrophilic infiltrate within the bronchiolar lumen and (iii) one patient (myelofibrosis) presented with exudative DAD with an intense hemorrhagic component (Figure 3 ). Only one of the five patients did not present acute interstitial changes. In this patient with esophageal cancer, death was secondary to pulmonary thromboembolism and bacterial pneumonia. Two patients had pulmonary thromboembolism (two patients with esophagus neoplasm). In four of five patients, bronchopneumonia coinfection due to S. pneumoniae was confirmed at autopsy ( Figure 3) .