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1.
Medicine (Baltimore) ; 99(43): e22818, 2020 Oct 23.
Article in English | MEDLINE | ID: covidwho-933927

ABSTRACT

INTRODUCTION: Severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) responsible for the COVID-19 pandemic has spread from Wuhan, China in December, 2019 to 216 countries and territories as of September 10, 2020 with 27.74 million cases and 899,911 confirmed deaths. The spectrum of disease is most commonly seen as a viral pneumonia with high grade fevers, shortness of breath, dry cough, and chest pain with radiologic evidence of bilateral, interstitial, ground glass opacities, and peripheral lung consolidation. Liver chemistries are frequently abnormal, with transaminases shown to be one-two times the upper limit of normal in most instances. The full spectrum of gastrointestinal involvement of the SARS-CoV-2 infection has yet to be fully seen.Patient concerns: We present a case of a young woman with SLE who developed severe abdominal pain, nausea and vomiting, rapidly progressing to acute hepatic failure and tested positive for SARS-CoV-2 infection. She had no respiratory symptoms. DIAGNOSIS: A thorough work-up of acute liver failure including liver biopsy confirmed acute hepatitis with viral like changes. Common viral causes of liver failure were ruled out. The patient had no recent travel history. INTERVENTIONS: The patient was started on hydroxychloroquine due to SLE, treated with N-Acetyl-Cysteine, and methylprednisolone. OUTCOMES: The patient improved with resolution of encephalopathy and normalization of her liver chemistries without any development of respiratory illness. CONCLUSION: This case details a unique presentation of likely SARS-CoV-2 infection. Until now, the literature has primarily described a respiratory illness and liver injury with mild transaminase elevations. Significant liver injury progressing to acute liver failure should be considered in those with SARS-CoV-2 infection.


Subject(s)
Betacoronavirus , Coronavirus Infections/diagnosis , Liver Failure, Acute/virology , Pneumonia, Viral/diagnosis , Adult , COVID-19 , Coronavirus Infections/complications , Female , Humans , Liver Failure, Acute/diagnosis , Pandemics , Pneumonia, Viral/complications , SARS-CoV-2
2.
Am J Case Rep ; 21: e925932, 2020 Oct 13.
Article in English | MEDLINE | ID: covidwho-854650

ABSTRACT

BACKGROUND Coronavirus disease 2019 (COVID-19) is a newly emerging disease that is still not fully characterized. It is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel virus that can be transmitted easily from human to human mainly by the respiratory route. Currently, there is no specific treatment for COVID-19 or a vaccine for prevention. The disease has various degrees of severity. It often presents with nonspecific symptoms such as fever, headache, and fatigue, accompanied by respiratory symptoms (e.g., cough and dyspnea) and other systemic involvement. Severe disease is associated with hemophagocytic syndrome and cytokine storm due to altered immune response. Patients with severe disease are more likely to have increased liver enzymes. The disease can affect the liver through various mechanisms. CASE REPORT We report an unusual case of SARS-CoV-2 infection in a 24-year-old man with no previous medical illness, who presented with mild respiratory involvement. He had no serious lung injury during the disease course. However, he experienced acute fulminant hepatitis B infection and cytokine release syndrome that led to multiorgan failure and death. CONCLUSIONS It is uncommon for SARS-CoV-2 infection with mild respiratory symptoms to result in severe systemic disease and organ failure. We report an unusual case of acute hepatitis B infection with concomitant SARS-CoV-2 leading to fulminant hepatitis, multiorgan failure, and death.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Hepatitis B virus , Hepatitis B/epidemiology , Liver Failure, Acute/etiology , Pneumonia, Viral/epidemiology , COVID-19 , Comorbidity , Humans , Liver Failure, Acute/diagnosis , Male , Pandemics , SARS-CoV-2 , Young Adult
3.
Pharmacotherapy ; 40(11): 1166-1171, 2020 11.
Article in English | MEDLINE | ID: covidwho-812649

ABSTRACT

Remdesivir is a direct-acting nucleoside RNA polymerase inhibitor with activity against the novel severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) virus used in the treatment of coronavirus disease 2019 (COVID-19) pneumonia. Here, we present two cases of suspected remdesivir-associated acute liver failure (ALF) in which the liver failure improved after continuous infusion acetylcysteine and withdrawal of remdesivir. Both patients had significant increases in transaminases between day 3 and day 10 of remdesivir therapy accompanied by coagulopathy and encephalopathy. After initiation of continuous infusion acetylcysteine, the transaminases of both patients rapidly improved. Ultimately, one patient fully recovered while the other died of suspected septic shock. Due to its novel nature and only recent widespread use, there are very little data on the risk of ALF from remdesivir. Additionally, the data for the use of acetylcysteine to manage non-acetaminophen-induced ALF are limited. It is important to consider the risk of remdesivir-associated ALF when weighing the risk versus benefits of use, and acetylcysteine may have a role in its management.


Subject(s)
Acetylcysteine/therapeutic use , Adenosine Monophosphate/analogs & derivatives , Alanine/analogs & derivatives , Antiviral Agents/adverse effects , COVID-19/drug therapy , Liver Failure, Acute/drug therapy , Acetylcysteine/administration & dosage , Adenosine Monophosphate/administration & dosage , Adenosine Monophosphate/adverse effects , Adenosine Monophosphate/therapeutic use , Aged , Aged, 80 and over , Alanine/administration & dosage , Alanine/adverse effects , Alanine/therapeutic use , Antiviral Agents/administration & dosage , Antiviral Agents/therapeutic use , Fatal Outcome , Female , Humans , Liver Failure, Acute/chemically induced , Liver Failure, Acute/diagnosis , Liver Function Tests , SARS-CoV-2 , Treatment Outcome
4.
Arch Pediatr ; 27(8): 502-505, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-802266

ABSTRACT

Although several typical manifestation of novel coronavirus disease 2019 (COVID-19) including respiratory symptoms, weakness, fever, and fatigue have been reported, some rare and novel manifestations have also been observed, particularly in children. We report a pediatric case of fulminant hepatic failure associated with COVID-19. Although the patient was treated for acute fulminant hepatic failure in the context of COVID-19, he died following the progression of the disease to stage 4 hepatic failure with encephalopathy and brain death.


Subject(s)
Betacoronavirus , Coronavirus Infections/diagnosis , Liver Failure, Acute/virology , Pneumonia, Viral/diagnosis , Betacoronavirus/isolation & purification , COVID-19 , Child , Coronavirus Infections/complications , Fatal Outcome , Humans , Liver Failure, Acute/diagnosis , Male , Pandemics , Pneumonia, Viral/complications , SARS-CoV-2
5.
United European Gastroenterol J ; 8(7): 814-819, 2020 08.
Article in English | MEDLINE | ID: covidwho-617210

ABSTRACT

BACKGROUND: Reports of liver injury in patients with novel coronavirus disease 2019 (COVID-19) are emerging from China and the USA. A wide variety of liver function test abnormalities and few cases of severe liver failure have been reported. No data on the hepatic phenotype from Europe are available at current. METHODS: We report a case series of 44 consecutive patients hospitalized for COVID-19 in Germany. RESULTS: At the time of admission, aspartate aminotransferase greater than the upper limit of normal was present in 70%, while alanine aminotransferase was elevated in 15.8%. Markers of cholestatic liver injury were altered only in a minority of patients. During hospitalization, 31% and 22% experienced increasing aspartate aminotransferase and alanine aminotransferase, respectively, when transaminases were normal at admission. Severe liver injury defined by 3×> upper limit of normal was observed in 9.1% over a mean time of 10.5 days. Importantly, patients exhibited cytotoxicity including lactate dehydrogenase and creatinine kinase elevations, but no signs of relevant liver function impairment. CONCLUSION: In summary, in a case series of hospitalized patients in Germany, cytotoxicity in the absence of severe liver dysfunction at admission and only few cases suggestive of severe liver injury during hospital were observed.


Subject(s)
Antiviral Agents/adverse effects , Betacoronavirus/pathogenicity , Chemical and Drug Induced Liver Injury/epidemiology , Coronavirus Infections/complications , Liver Failure, Acute/epidemiology , Pneumonia, Viral/complications , Adult , Aged , Aged, 80 and over , Alanine Transaminase/blood , Aspartate Aminotransferases/blood , Biomarkers/blood , COVID-19 , COVID-19 Testing , Chemical and Drug Induced Liver Injury/blood , Chemical and Drug Induced Liver Injury/diagnosis , Chemical and Drug Induced Liver Injury/etiology , Clinical Laboratory Techniques/statistics & numerical data , Coronavirus Infections/diagnosis , Coronavirus Infections/drug therapy , Coronavirus Infections/epidemiology , Coronavirus Infections/virology , Electronic Health Records/statistics & numerical data , Female , Germany/epidemiology , Humans , Liver/drug effects , Liver/virology , Liver Failure, Acute/blood , Liver Failure, Acute/diagnosis , Liver Failure, Acute/virology , Liver Function Tests/statistics & numerical data , Male , Middle Aged , Pandemics , Pneumonia, Viral/drug therapy , Pneumonia, Viral/epidemiology , Pneumonia, Viral/virology , Retrospective Studies , SARS-CoV-2 , Young Adult
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