COVID-19 Presenting as Acute Hepatitis

Original Article: Praneet Wander, Marcia Epstein, and David Bernstein, COVID-19 Presenting as Acute Hepatitis, Am J Gastroenterol

Author of summary: Gabriella Assante; Reviewer: Giulia Peserico

Original Article Published on April 15th, 2020

This is the first worldwide case of COVID19 infection where an acute and nonicteric hepatitis has been reported before respiratory symptoms.

Since December 2019, the most common clinical manifestation due Covid19 infection, have always been respiratory symptoms such as fever, shortness of breath and cough whilst the presence and the role of liver abnormalities need to be further investigated. Neverthless, a first case of Acute hepatitis a way before the usual COVID19 symptoms has been described as follows.

A 59-year-old woman without Sars-CoV-2 infection manifestations, was admitted owing to dark urine and abnormalities in liver test along with her personal medical history. Indeed, she had reported history of Human immunodeficiency virus, hypertension, hyperlipidemia as well as Graves disease. Moreover, her medications were including clonidine, fish oil, levothyroxine, amlodipine,

propranolol, hydrochlorothiazide, MVI, and Genvoya (elvitegravir, cobicistat, emtricitabine, and tenofovir alafenamide).

The patient presented a temperature of 37.2°C, normal lung examination, a normal liver with patent vasculature and negative results for all respiratory viral screening tests as wells as for hepatitis A, B, C, E, Cytomegalovirus, Epstein-Barr. Also, blood cultures and screening for autoimmune markers were negative. The laboratory results revealed white blood cell count 3.71 G/L, platelets 140 G/L, serum bilirubin 0.6 mg/dL (N: < 25), AST 1230 IU/L (N: < 50), ALT 697 IU/L (N < 50), alkaline phosphatase 141 IU/L (N: < 125), serum albumin 3.1 g/dL (N > 3.5) INR 1.08, and

ferritin 6,606 ng/mL (N < 150).

Over the second day (18 hours later the admission) a fever of 39°C was reported coupled with SpO2 94% on room air and Bilateral interstitial pneumonia as well as a positivity for SARS-CoV-2 and she was then been helped with 3L of O2. Thereby a therapy of hydroxychloroquine was initiated on the day 4 and after 4 days she was discharged with serum bilirubin 0.6 mg/dL, AST 114 IU/L, ALT 227 IU/L, alkaline phosphatase 259 IU/L, serum albumin 2.8 g/dL, and INR 1.13.

Overall, the study of hydroxychloroquine is ongoing in clinical trials, as for example a Chinese study reported that it has no benefit in treating COVID19 infection despite showing its in vitro activity against SARS-CoV and SARS-CoV-2 and being used so far for the treatment of the novel virus along with Azithromycin .


Liver tests abnormality and its correlation with COVID19 need to be further investigated but according to the clinical cases presented above, patients with risk factors for COVID19 presenting with acute hepatitis should be isolated and tested for SARS-Cov2.

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