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COVID-19 Presenting as Acute Icteric Hepatitis
Warren R Balaja1, Sarah Jacob1, Soheila Hamidpour2
1Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas City, USA.
Cureus
|August 16, 2021
Summary
This case report details a patient with coronavirus disease 2019 (COVID-19) presenting with jaundice and acute hepatitis, not respiratory symptoms. This highlights a rare initial presentation of COVID-19, challenging typical disease severity associations.
Area of Science:
- Hepatology
- Infectious Diseases
- Virology
Background:
- The clinical spectrum of coronavirus disease 2019 (COVID-19) continues to expand as understanding evolves.
- Gastrointestinal and hepatic manifestations of COVID-19 are increasingly recognized, though often secondary to systemic illness.
Observation:
- A case of COVID-19 is presented where the initial and sole manifestation was acute icteric hepatitis, with no preceding or concurrent respiratory symptoms.
- The patient presented with jaundice and elevated liver enzymes, indicative of significant hepatic inflammation.
Findings:
- This represents a rare instance of jaundice as the primary presenting symptom of COVID-19, with acute hepatitis as the exclusive initial presentation.
- Despite severe hepatitis, the patient experienced a benign course of COVID-19, underscoring a dissociation between liver enzyme elevation and overall disease severity.
Implications:
- Physicians should consider COVID-19 infection in the differential diagnosis of acute icteric hepatitis, even in the absence of respiratory symptoms.
- This case prompts further investigation into the mechanisms of COVID-19-induced hepatitis and its varied clinical presentations.
- The findings challenge conventional assumptions linking COVID-19 severity to the degree of aminotransferase elevation.
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