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COVID-19 pneumonia in a child with hepatic encephalopathy: A case study

Naghi Dara1, Naghmeh Sharifi2, Masoud Ghanbari Boroujeni3

  • 1Pediatric Gastroenterology, Hepatology, and Nutrition Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Iranian Journal of Child Neurology
|February 9, 2021
PubMed

Insights

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can cause fatal pneumonia and acute liver failure in children with underlying liver cirrhosis. This rare outcome highlights the potential severity of COVID-19 in vulnerable pediatric populations.

Area of Science:

  • Pediatric Gastroenterology and Hepatology
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, typically presents with milder symptoms in children compared to adults.
  • Gastrointestinal issues and elevated liver enzymes are observed in a significant percentage of pediatric COVID-19 cases, but severe liver injury is rare.
  • The role of comorbidities in pediatric COVID-19 outcomes, particularly liver-related complications, remains incompletely understood.

Observation:

  • A 14-year-old boy with pre-existing liver cirrhosis presented with simultaneous pneumonia and acute liver failure.
  • This case represents an extremely rare, fatal presentation of COVID-19 in a pediatric patient with significant comorbidities.
  • The simultaneous occurrence of severe respiratory and hepatic dysfunction underscores the complex interplay of SARS-CoV-2 infection and underlying health conditions.

Findings:

  • The patient experienced fatal outcomes due to severe pneumonia secondary to SARS-CoV-2 infection, coupled with acute liver failure.
  • This case is the first reported instance of fatal acute liver failure associated with SARS-CoV-2 in a pediatric patient with liver cirrhosis.
  • The combination of SARS-CoV-2 and liver cirrhosis led to a catastrophic multi-organ system failure.

Implications:

  • This case highlights the critical need for vigilant monitoring of liver function in pediatric patients with COVID-19, especially those with pre-existing liver conditions.
  • It suggests that children with comorbidities, such as liver cirrhosis, may be at higher risk for severe and fatal outcomes from SARS-CoV-2 infection.
  • Further research is warranted to elucidate the mechanisms of SARS-CoV-2-induced liver injury in children and to identify risk factors for severe disease progression.

Keywords:
COVID-19childrenchronic liver cirrhosishepatic encephalopathypneumonia

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