ABSTRACT
This article presents the features of the course of liver cirrhosis (LC) in a patient with a new coronavirus infection. The patient had no specific respiratory symptoms of COVID-19 (CoronaVirus Disease 2019), and the reason for outpatient examination for SARS-CoV-2 (severe acute respiratory syndrome coronavirus) RNA was the presence of these symptoms in relatives. Previously, patient E. had been undergoing in-patient examination and treatment for abdomen volume build-up against the background of prolonged alcoholization, and was diagnosed with alcoholic class B LC according to Child-Pugh classification. Conservative therapy was administered, and the patient was discharged with regression of ascites. Within a week after SARS-CoV-2 identification, patient E. showed signs of LC decompensation in the form of increasing abdominal volume, which required repeated inpatient treatment, during which portal vein thrombosis (PVT) and progression of chronic liver disease (CLD) in the post-coid period were revealed. Literature data on 30-day mortality in patients with LC against COVID-19 background are presented, as well as my own observations on the example of 580 case histories. Complications of new coronavirus infection in patients with CLD, methods of their correction are considered here. This observation demonstrates the social significance of the problem of COVID-19 incidence in patients with LC, the necessity for screening for COVID-19 in case of the presence of decompensation episodes, as well as active prevention of infection in these patients.
ABSTRACT
The article presents clinical case of the jaundice development and severe hyperenzymemia in GAM–Covid-VAK (Sputnik V) vaccination against COVID-19 in a 69-year-old patient. History — systematic use of non-steroidal anti-inflammatory drugs due to persisting pain after knee arthroplasty in 2018;frequent trips for several years to another region for sanatorium treatment, the use of mineral water. The diseases caused by hepatitis viruses, drug damage and post-vaccination reaction were included in diagnostic search. The markers of hepatitis B and C infection viruses were not detected during the enzyme immunoassay and polymerase chain reaction. The indicator for determining the relationship of a drug with the liver damage development was 6 points (borderline value) and only indicated the likelihood of drug hepatotoxicity. At the same time, it is known from history that repeated administration of the drug did not cause liver dysfunctions. The diagnosis of coronavirus infection was established based on the identification of SARS-CoV-2 in the hospital with repeated laboratory testing and competing diagnosis of hepatitis A has been confirmed on the basis of hepatocellular damage and the presence of serological marker of hepatitis A virus (immunoglobulin M antibodies). The treatment was continued in the infectious hospital, where the diagnosis of co-infection was confirmed. The pneumofibrotic changes in the S5 region of the left lung were revealed according to computed tomography. The normalization of aminotransferase activity and bilirubin was noted during dynamic observation. Apparently HAV infection led to a decrease in the immune response, the formation of an insufficient level of neutralizing antibodies in vaccinated against COVID-19 patient M. and contributed to the development of a new coronavirus infection with minimal manifestations in contact with SARS-CoV-2. © 2021 Eksperimental'naya i Klinicheskaya Gastroenterologiya. All rights reserved.