COVID-19-Triggered Acute Liver Failure and Rhabdomyolysis: A Case Report and Review of the Literature.

COVID-19 is primarily known for its respiratory tract involvement, often leading to severe pneumonia and exacerbation of underlying diseases. However, emerging evidence suggests that COVID-19 can result in multiorgan failure, affecting organs beyond the respiratory system. We present the case of a 62-year-old male with COVID-19 who developed acute liver failure (ALF) and rhabdomyolysis in the absence of respiratory failure. Initially, the patient presented with significantly elevated aspartate transaminase (5398 U/L) and alanine transaminase (2197 U/L) levels. Furthermore, a prolonged prothrombin time international normalized ratio (INR) of 2.33 indicated the diagnosis of ALF without hepatic coma, according to Japanese diagnostic criteria. The patient also exhibited elevated creatine kinase (9498 U/L) and a mild increase in creatinine (1.25 mg/dL) levels, but both values improved with intravenous fluid support and molnupiravir administration. To our knowledge, this is the first reported case presenting with both ALF and rhabdomyolysis associated with COVID-19. In addition, we review the existing literature to summarize previously reported cases of ALF triggered by SARS-CoV-2. This case report underscores the significance of recognizing COVID-19 as a significant contributing factor in the development of multiorgan failure. Furthermore, it suggests that COVID-19 can lead to severe illness, irrespective of the absence of respiratory failure.

Quantification of Risperidone Contained in Precipitates Produced by Tea Catechins Using Nuclear Magnetic Resonance.

A mixture of risperidone and eight major tea catechins: (-)-epicatechin-3-O-gallate (ECg), (-)-epigallocatechin-3-O-gallate (EGCg), (-)-catechin-3-O-gallate (Cg), (-)-gallocatechin-3-O-gallate (GCg), (-)-epicatechin (EC), (-)-epigallocatechin (EGC), (+)-catechin (CA), or (+)-gallocatechin (GC), in tartaric acid buffer (pH 3.0) afforded a precipitate. Amounts of risperidone and these catechins in the precipitate were measured by quantitative 1H-NMR (qNMR). About half or more of risperidone used was precipitated by gallated catechins ECg, EGCg, Cg, and GCg; on the other hand, it was precipitated little by non-gallated catechins EC, EGC, CA, and GC. Furthermore, risperidone was precipitated more by 2,3-trans gallated catechins Cg and GCg than 2,3-cis gallated catechins ECg and EGCg. Regarding the amount of tea catechins in the precipitate obtained by a mixture of risperidone and Catechin Mixture, the amounts of 2,3-cis gallated catechins EGCg and ECg were much larger than those of the other green tea catechins GCg, EC, EGC, CA, and GC. It was considered that risperidone was mainly precipitated by EGCg and ECg in Catechin Mixture. Therefore, it can be concluded that when patients take risperidone with catechin-rich beverages, the efficacy of risperidone reduces, mainly because the 2,3-cis gallated catechins EGCg and ECg form complexes with risperidone and precipitate.