ABSTRACT
Background: Coronavirus disease 2019 (COVID-19) is a worldwide pandemic that has affected millions of lives since December 2019 Research is being done to determine the impact COVID-19 has on different organ systems There is limited information of Covid-19's impact on the liver as manifested by abnormal hepatic test results Methods: Clinical Case Report Results: Patient is a 70-year-old male with history of Parkinson's disease, chronic obstructive pulmonary disease, diabetes mellitus, hyperlipidemia, and benign prostatic hyperplasia who presented with fever and weakness and was admitted for sepsis versus COVID-19 infection Patient reported fevers of 104 F Patient tachypneic, tachycardic, with oxygen saturating at 94% room air at admission COVID-19 PCR test positive Patient was admitted to medical intensive care with progressive respiratory insufficiency. ABG PH 7.399, PCO2 34, PO2 78. WBC 6.63, H&H 13 1/36 9, Platelets 147, Sodium 132, Potassium 3 4, Chloride 96, CO2 23, Anion gap 16, Glucose 330, BUN/ creatinine 11/0 88, Total Bilirubin 0 8, Alk Phos 141, AST 33, ALT 33 CT angiogram negative for pulmonary embolism Initial chest x ray showed bibasilar atelectasis/infiltrates. Repeat chest x ray's showed unresolved bibasilar opacities Blood cultures negative Patient was treated with Azithromycin and IV Ceftriaxone Patient's Alkaline Phosphatase showed upward trend from Day 7 At admission, Alkaline Phosphatase was 141, Day 2 145, Day 3 119, Day 4 124, Day 5 163, Day 6 154, Day 7 245, Day 8 361, Day 9 520, Day 10 696, Day 11 835, Day 12 1266, and Day 13 1324 RUQ u/s had normal size common bile duct at 4 5 mm GGT of 1298, indicating liver etiology of Alkaline Phosphatase elevation Day 13 AST 65 and ALT 53 Ceftriaxone and Azithromycin were discontinued and transitioned to meropenem on Day 9 Patient was started on meropenem for empiric coverage of possible biliary infection, but with no improvement On Day 12, Vit C, zinc, and meropenem discontinued to ensure lab abnormalities not secondary to agents Day 13 Alkaline Phosphatase continued to increase The etiology of his lab abnormalities remains unclear Differential includes COVID related pathology or medication induced Day 13, patient died after being placed on comfort care due to cardiac arrest secondary to hypoxic respiratory failure secondary to COVID 19 pneumonia with moderate to severe ARDS Conclusion: Data on liver abnormalities on COVID-19 patients is limited Recent literature only highlights an increase in ALT and AST due to target of COVID-19 on ACE 2 positive cholangiocytes in the liver To date, research has only noted elevated levels of alanine aminotransferase, aspartate aminotransferase, total bilirubin, and gamma-glutamyl transferase levels to more than 3× the upper limit of normal in COVID-19 patients The sole elevation of Alkaline Phosphatase with concomitant rise of GGT is the first documented here.