Severe hypertransaminasemia in a pregnant woman with SARS-CoV-2 infection

ABSTRACT

Description of the case A 38-year-old patient of Moroccan ethnicity, who had vaginally delivered a healthy baby girl in the obstetric ward the previous night, was transferred to the CoViD Hub of Varese Hospital due to the onset of nausea and emesis and severe hypertransaminasemia. The patient was known to be positive for SARS-CoV-2 infection but was not taking any medications at home. Physical examination was normal, except for scleral icterus. Laboratory tests were significant for bilirubin 2.52 mg/dl, AST 2729 U/L, ALT 513 U/L, LDH>1800 U/L;we also found mild thrombocytopenia (104,000/L), INR 1.24, d-dimer>9000 ng/ml, prolonged prothrombin time, and reduced fibrinogen levels. Serological tests were negative for hepatitis A, B, C, and E, EBV, CMV, HSV type 1 and 2, and HIV. Autoimmune or toxic hepatitis was excluded. No teardrop-shaped erythrocytes were visualized. No vaginal bleeding was found. HRCT showed diffuse multiple bilateral consolidations, and abdomen CT excluded portal thrombosis. Infusive fluid and prophylactic therapy with sodium enoxaparin were started. During hospitalization, the detection of SARS-CoV-2 RNA in the nasopharynx sample was persistently positive. On the tenth day post-hospitalization, the patient was discharged with normalization of liver values and clinical well-being. Conclusions: Severe acute hepatitis has been reported in patients with severe CoViD-19, but it is rare in pregnant women with asymptomatic SARS-CoV-2 infection without other pregnancy-related disorders, as in the present case.