Stony coral tissue loss disease (SCTLD) was first documented in Florida in 2014 and has since spread through the Caribbean causing unprecedented mortality in more than 20 species of corals. The cause of SCTLD is unknown, but bacteria are suspected based on regression of gross lesions in some corals treated with antibiotics. Limited pathology studies on SCTLD exist, but it is likely that ‘SCTLD’ is a general term encompassing tissue loss disease of unexplained origin. Here, we examined pathology of lesions in corals from the US Virgin Islands where SCTLD has recently emerged. The typical histologic lesion of SCTLD in Florida corals was lytic necrosis comprising vacuolation and necrosis of mucus cells with erosion of mesoglea and misshapen endosymbionts with variably sized intracytoplasmic granules and common occurrence of filamentous viral-like particles in endosymbionts visible on electron microscopy (EM). In contrast, USVI corals had mainly lytic mucus cell hypertrophy and necrosis with no involvement of mesoglea, endosymbiont pathology at the light microscopy level was less evident, and VLP were rarely seen on EM. We suspect SCTLD is likely more complex with multiple presentations and potential etiologies depending on geographic region. Further pathological studies from other regions might help refine the case definition of SCTLD.