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COVID-19 Induced Cholangiopathy: A Case Report
Bassem Al Hariri1,2,3, Muhammad Sharif1,2, Lujain Al-Emadi1
1Hamad Medical Corporation, Doha, Qatar.
Case Reports in Gastroenterology
|July 17, 2025
Summary
COVID-19 can cause serious liver injury, including a rare condition called COVID-19-induced cholangiopathy. This case highlights the importance of recognizing and managing this liver complication in patients with severe COVID-19.
Area of Science:
- Hepatology
- Infectious Diseases
- Gastroenterology
Background:
- COVID-19 primarily affects the respiratory system but can lead to multi-organ complications, including liver injury.
- Mechanisms of COVID-19 liver injury include direct viral effects, inflammation, hypoxia, and drug-induced liver injury (DILI).
- Post-COVID cholangiopathy is an emerging liver complication with potential autoimmune overlap.
Observation:
- A 60-year-old male with COVID-19 pneumonia developed elevated liver enzymes one week after admission.
- Initial suspicion of drug-induced liver injury (DILI) and treatment with ursodeoxycholic acid (UDCA) did not resolve the liver dysfunction.
- Magnetic resonance cholangiopancreatography revealed findings consistent with COVID-19-induced cholangiopathy.
Findings:
- COVID-19-induced cholangiopathy is characterized by periportal inflammation, intrahepatic biliary dilatation, and stricturing.
- Doubling the UDCA dosage led to gradual biochemical improvement in liver function tests.
- The patient was discharged against medical advice despite partial recovery.
Implications:
- COVID-19-induced cholangiopathy is a rare but significant liver complication requiring multidisciplinary management.
- Further research is necessary to understand the long-term hepatic sequelae of COVID-19.
- Early recognition and appropriate treatment strategies are crucial for managing COVID-19-related liver injury.
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