<p>Abstract</p> <p>Background</p> <p>Host genetic factors may play a role in the occurrence and progress of SARS-Cov infection. This study was to investigate the relationship between tumor necrosis factor (TNF)-<it>α </it>gene polymorphisms with the occurrence of SARS-CoV infection and its role in prognosis of patients with lung interstitial fibrosis and femoral head osteonecrosis.</p> <p>Methods</p> <p>The association between genetic polymorphisms of <it>TNF-α </it>gene and susceptibility to severe acute respiratory syndromes (SARS) was conducted in a hospital-based case-control study including 75 SARS patients, 41 health care workers and 92 healthy controls. Relationships of TNF-α gene polymorphisms with interstitial lung fibrosis and femoral head osteonecrosis were carried out in two case-case studies in discharged SARS patients. PCR sequencing based typing (PCR-SBT) method was used to determine the polymorphisms of <it>TNF-α </it>gene in locus of the promoter region and univariate logistic analysis was conducted in analyzing the collected data.</p> <p>Results</p> <p>Compared to TT genotype, the CT genotype at the -204 locus was found associated with a protective effect on SARS with OR(95%<it>CI</it>) of 0.95(0.90–0.99). Also, TT genotype, CT and CC were found associated with a risk effect on femoral head necrosis with ORs(95%<it>CI</it>) of 5.33(1.39–20.45) and 5.67(2.74–11.71), respectively and the glucocorticoid adjusted OR of CT was 5.25(95%CI 1.18–23.46) and the combined (CT and CC) genotype OR was 6.0 (95%<it>CI </it>1.60–22.55) at -1031 site of <it>TNF-α </it>gene. At the same time, the -863 AC genotype was manifested as another risk effect associated with femoral head necrosis with OR(95%<it>CI</it>) of 6.42(1.53–26.88) and the adjusted OR was 8.40(95%CI 1.76–40.02) in cured SARS patients compared to CC genotype.</p> <p>Conclusion</p> <p>SNPs of <it>TNF-α </it>gene of promoter region may not associate with SARS-CoV infection. And these SNPs may not affect interstitial lung fibrosis in cured SARS patients. However, the -1031CT/CC and -863 AC genotypes may be risk factors of femoral head necrosis in discharged SARS patients.</p