Just saw this case on the pathology rotation:
A slightly overweight, otherwise healthy 50ish year-old man, 5 days ago starts feeling tired and gets a slight fever (~100 F). He goes on a trip with some friends and returns 2 days later. At that point he is feeling much more tired, his muscles ache a bit, he is starting to get short of breath and his fever is a bit worse (~102 F). He goes to the local ER where they think he might have H1N1 and because of his worsening shortness of breath he is admitted. Over the next day his condition dramatically worsens. He is intubated, his fever skyrockets (~109 F (!)) and he is transferred to a larger hospital. He dies within 12 hours of arriving at the larger hospital. He is determined to be H1N1 positive.
On autopsy, except for his lungs, all his organs show no signs of any disease or abnormality. His lungs, however, weigh about 1200 and 1300 grams each (normal, i think, is about 450 and 500 grams for left and right lungs). It has multiple areas of necrosis, hemorrhage and consolidation (like a really, really bad pneumonia). What goes beyond a normal pneumonia is that it covers the entirety of both lungs (ARDS) and even goes up the airway to the trachea, which also shows inflammation and hemorrhage.