COVID-19 as a cause of acute hepatitis

Authors:

Miró Vicedo C^a, Ruipérez Cebrián C^b, González de Dios J^c

^a MIR-Pediatría. Servicio de Pediatría. Hospital General Universitario Dr. Balmis. Alicante, España.
^bServicio de Pediatría. Hospital General Universitario Dr. Balmis. Alicante, España.
^cServicio de Pediatría. Hospital General Universitario de Alicante. Departamento de Pediatría. Universidad Miguel Hernández. ISABIAL-Instituto de Investigación Sanitaria y Biomédica. Alicante. España.

Reference of this article.:

Miró Vicedo C, Ruipérez Cebrián C, González de Dios J. COVID-19 como causa de hepatitis aguda . Rev Pediatr Aten Primaria. 2022;24:417-9..

Published in Internet: 29/12/2022

Abstract:

In the pathogenesis of acute liver damage related to SARS-CoV-2 infection, several hypotheses have been made: hepatotoxicity of drugs in the treatment of COVID-19; cytokine storm triggered by the immune hyperactivation; liver damage secondary to a situation of shock and hypoperfusion; and direct cytopathic effect of the virus.

We repot the case of a previously healthy 10-year-old boy who, in December 2020, developed acute hepatitis with a cytolytic pattern (ALT 1823 U/L and AST 1092 U/L), without associated increase in other cholestatic parameters, and who after the study, it could only be attributed to COVID-19, since he did not receive drugs that could damage the liver, nor did he present hemodynamic instability or involvement of other organs or multi-inflammatory disease. The diagnosis was made after exclusion of other microbiological causes and thanks to the detection of the virus both in the respiratory tract and in feces. A discussion is made about the possible direct cytotoxic effect of the virus and the current literature that supports this hypothesis, as well as the practicality of PCR detection of SARS-CoV-2 in feces for the diagnosis of COVID-19 with gastrointestinal involvement or liver-predominant involvement.

Keywords: Hepatitis. SARS-CoV-2. COVID-19.