Cucumber mosaic virus (CMV) D satellite RNA (satRNA) attenuates the symptoms induced by CMV in most plants, but causes leaf epinasty and systemic necrosis in tomato plants, where programmed cell death (PCD) is involved. However, our understanding of the cellular and molecular responses to the infection of CMV D satRNA that result in this lethal disease remains limited. In this article, we show for the first time, by histochemical and molecular analysis, that multiple defense responses are specifically induced in CMV and D satRNA (CMV/D satRNA)-infected tomato plants but not in mock-inoculated or CMV-infected plants. These responses include callose deposition and hydrogen peroxide accumulation in infected plants. Furthermore, the transcription of several tomato defense-related genes (e.g., PR-1a1, PR-1b1, PR-2, and PR-10) were activated, and the expression of tomato PR-5 and some abiotic and biotic stress-responsive genes (e.g., catalase II and tomato analogs of Arabidopsis AtBI-1 and tobacco hsr203j) are enhanced. The activation and increase in expression of these genes is correlated with the appearance of leaf epinasty and the development of systemic necrosis in infected tomato plants, while increased expression of the hsr203j analog precedes the development of any disease symptoms. The spatial and temporal expression patterns of these genes as detected by RNA in situ hybridization point to the involvement of a complex developmental program that accompanies disease development resulting from CMV/D satRNA infection.