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Pediatric Acute Liver Failure Due to Type 2 Autoimmune Hepatitis Associated With SARS-CoV-2 Infection: A Case Report

Julie Osborn1, Sara Szabo2, Anna L Peters1,3

  • 1Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.

JPGN Reports
|May 4, 2022
PubMed

Insights

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can uncommonly cause pediatric acute liver failure. This case links SARS-CoV-2 to autoimmune hepatitis, successfully treated with steroids.

Area of Science:

  • Pediatric Hepatology
  • Infectious Diseases
  • Immunology

Background:

  • Elevated liver enzymes are common in children hospitalized with SARS-CoV-2.
  • Pediatric acute liver failure (PALF) is a rare manifestation of COVID-19.
  • Autoimmune liver diseases can present with acute liver injury.

Observation:

  • A previously healthy 3-year-old girl developed PALF after a mild SARS-CoV-2 infection.
  • Viral hepatitis and multisystem inflammatory syndrome in children (MIS-C) were ruled out.
  • Liver biopsy revealed acute submassive hepatocyte necrosis with T-cell infiltration.

Findings:

  • The patient was diagnosed with type 2 autoimmune hepatitis.
  • High-dose methylprednisolone treatment rapidly normalized liver function tests (ALT, AST, INR) and ammonia levels.
  • Liver transplantation was successfully avoided.

Implications:

  • This case suggests a potential association between SARS-CoV-2 infection and the development of autoimmune hepatitis.
  • Early recognition and immunosuppressive therapy may prevent the need for liver transplantation in such cases.
  • Further research is warranted to understand the immunopathogenesis linking SARS-CoV-2 and autoimmune liver disease.

Keywords:
COVID-19acute liver failureautoimmune hepatitis

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