Histolologic sections of lungs showed alveolar infiltrates of neutrophils, lymphocytes, macrophages, erythrocytes and fibrin (Image 01). Multifocal enlarged, darkly staining smudge cells were present (Image 02). Postmortem lung tissue cultures were positive for adenovirus. Thyroid showed extensive replacement of underlying parenchyma by lymphocytes and plasma cells with focal lymphoid germinal center formation ( Image 03). Follicles showed Hurthle cell hyperplasia (Image 04) and focal clear cell metaplasia. Adrenal glands showed thin partially discontinuous cortex with small islands of cells interspersed with lymphocytes and plasma cells (Images 05 and 06). Residual cortical cells have enlarged , compact eosinophilic cytoplasm (Image 07) and occasional nuclear pseudoinclusions (Image 08). There was also multifocal cortical hemorrhage (Image 09). The medulla was normal.