COVID-19 presenting as fulminant hepatic failure: A case report

Area of Science:

• Hepatology
• Infectious Diseases
• Virology

Background:

• The COVID-19 pandemic, caused by SARS-CoV-2, has led to widespread illness and mortality globally.
• While typically presenting as viral pneumonia, SARS-CoV-2 can affect multiple organ systems.
• Gastrointestinal symptoms and liver enzyme abnormalities are reported, but the full spectrum remains under investigation.

Observation:

• A young female patient with Systemic Lupus Erythematosus (SLE) presented with severe abdominal pain, nausea, and vomiting.
• She rapidly progressed to acute liver failure and tested positive for SARS-CoV-2.
• Notably, this patient exhibited no respiratory symptoms.

Findings:

• Diagnostic work-up, including liver biopsy, confirmed acute hepatitis with viral-like changes.
• Common viral etiologies for liver failure were excluded.
• The patient's condition improved with medical treatment, showing resolution of encephalopathy and normalized liver chemistries.

Implications:

• This case presents a unique manifestation of SARS-CoV-2 infection, emphasizing its potential to cause severe hepatic injury.
• The findings suggest that significant liver injury, progressing to acute liver failure, should be considered in the differential diagnosis of SARS-CoV-2 infected individuals.
• Further research is warranted to understand the mechanisms and full spectrum of gastrointestinal and hepatic involvement in COVID-19.