ABSTRACT
Background: Abnormalities in liver function tests (LFTs) are found in 14%-53% of hospitalized COVID-19 patients. These could occur in patients with or without previous chronic liver diseases. Knowing the risk factor of liver manifestations in COVID-19 subjects is crucial for the proper management of these patients. Objective(s): We aimed to identify the risk factors for liver manifestations as well as other risk factors in COVID-19 subjects who complained of digestive manifestations. Material(s) and Method(s): COVID-19 patients with and without liver manifestations at the Emergency Department of Al Fallujah Teaching Hospital were enrolled in this study. This study covered a period from September 15, 2022, to April 22, 2022. Comparisons between patients with or without abnormal LFTs were made. The possible risk variables connected to abnormal LFTs and hepatic manifestation were investigated using univariable and multivariable logistic regression analysis. Result(s): Out of 100 COVID-19 patients, there were 64 suffering from mild gastrointestinal (GI) symptoms. There were 26 mild cases with abnormal LFTs (40.6%). Although there were nine (total number 22) and seven (total number 14) of the moderate and severe cases with liver involvement, there was no statistically significant difference between the digestive manifestations severity and liver involvement. Increased alanine aminotransferase (ALT) levels were linked to a greater incidence of LFTs, according to multivariable analysis (odds ratio [OR]: 45.05;P < 0.0001), elevated aspartate aminotransferase (AST;OR: 3.462;P = 0.00041), elevated direct bilirubin (DBIL) (OR: 3.643;P < 0.001), and elevated d-dimer levels [OR]: 2.690;P < 0.0137) in liver involvement group compared with non-involvement patients. Conclusion(s): Elevated ALT, AST, DBIL, and d-dimer are potential risk factors for liver manifestations in COVID-19 patients with digestive symptoms.
ABSTRACT
Background: T-cell chronic active Epstein-Barr virus infection (CAEBV) is a rare disease in which patients have the Epstein-Barr virus (EBV) present mainly in the T-cells, which infiltrate tissues like the liver, and bone marrow. Patients eventually develop liver failure, hemophagocytic lymph histiocytosis (HLH), coronary artery aneurysms, EBV infiltrating T-cells impairing organ function, or T-cell lymphomas. Prognosis is poor. The current treatment of choice is an allogeneic hematopoietic stem cell transplant. A study by the NIH and Baylor College of Medicine, which reviewed 28 years of data, only found 19 cases of CAEBV. We aim to report a rare case of T-cell chronic active Ebstein-Barr Virus (CAEBV) complicated by the development of HLH and T-Cell LPD. Method(s): A chart review of the CAEBV patient was performed, focusing on disease progression, treatment plans, and complications. Result(s): A 45-year- old Latin American woman from Mexico initially presented with abnormal liver enzymes after taking herbal medications. The patient underwent a liver biopsy and was initiated on prednisone for possible autoimmune hepatitis pending the biopsy report. The liver biopsy showed EBV hepatitis with EBV positive atypical T-cell infiltrate with steatohepatitis and marked steatosis. Prednisone was stopped, and the patient was referred to Hematology. Plasma EBV level was elevated to 3300 IU/mL. The patient was readmitted for sepsis and pancytopenia prior to being seen by Hematology. Bone marrow biopsy showed EBV+T-cell LPD and HLH, and the patient was started on dexamethasone and rituximab. The patient improved, and dexamethasone was weaned off. Subsequently the patient has had numerous hospital admissions for ESBL UTI, CoNS bacteremia, aspiration pneumonia, vocal cord dysfunction, EBV pneumonia, PCP pneumonia, chemotherapy-induced neuropathy, neutropenic fever, chronic respiratory failure and EBV reactivation. The patient underwent multiple rounds of chemotherapy with rituximab and R-CHOP regimen for persistent HLH. In spite of the treatment, the patient developed EBV encephalitis, further complicated by COVID -19 infection. Her family opted for comfort care, and the patient passed away in the hospital. Conclusion(s): Approximately 95% of adults are infected with EBV at some point in their lives and are asymptomatic in most cases. Very rarely do patients develop CAEBV -a life-threatening disease. Allogeneic stem cell transplant should be considered early on in the disease. Unfortunately, our patient had social factors such as lack of insurance and social support that prevented her from getting a timely stem cell transplant. (Figure Presented).