Internal Medicine Staten Island University Hospital, Northwell Health Staten Island, NY
Dhineshreddy Gurala, MD1, Hassan Almoussawi, MD2, Jobin Philipose, MD1, Jeffrey R. Abergel, MD2; 1Staten Island University Hospital, Northwell Health, Staten Island, NY; 2Staten Island University Hospital, Staten Island, NY
Introduction: In 2019 December, an outbreak of novel coronavirus caused by Severe Respiratory Distress Syndrome-Corona Virus 2 (SARS-CoV2) started in Wuhan, China. SARS-CoV2 mainly causes fever as well as respiratory symptoms such as cough and shortness of breath (SOB). Gastrointestinal/hepatic sequelae such as diarrhea, nausea, vomiting, and elevated liver enzymes have been reported as well. Studies and data so far on coronavirus infections from China, Singapore, and other countries showed that liver enzymes elevation could be seen in 20-50% of cases. More severe disease can correlate with the worsening of liver enzymes. However, acute liver failure in patients with COVID 19 has not been described. Herein we report the first case of acute liver failure in an elderly patient with COVID 19 infection, who did not have any known preexisting liver disease.
Methods: 80-year old male presented with fever, productive cough, and SOB for 4-5 days. Vital signs were stable except for temperature of 101.6F. Initial laboratory testing showed normal liver enzymes. He tested positive for COVID 19 and was started on hydroxychloroquine. Elevate liver enzymes were observed on day 4 without any asterixis or encephalopathy. On day 6, the patient became encephalopathic with increased international normalized ratio suggestive of acute liver failure. His family declined N Acetyl Cysteine administration. Transfer to live transplant center was not attempted per the family’s request. Other biochemical tests for acute and chronic liver disease were negative. The patient’s respiratory status gradually deteriorated requiring more oxygen support. He then developed cytokine release syndrome and expired on day 9. Discussion: In summary, we describe the first case of acute liver failure caused by the COVID-19 infection. Acute liver failure was diagnosed clinically, by rising LFTs and INR as well as progressive encephalopathy. We could not conclusively prove that the COVID-19 was the etiologic agent as the patient declined a liver biopsy. However, alternative causes of acute liver failure were effectively ruled out. Bloodwork didn’t identify another etiology and the patient’s hypotension was too late in his course and too mild to cause ischemic hepatopathy. Additionally, none of his medications were among the usual suspects for acute liver failure. As we learn more about this new infection, we expect to better understand the spectrum, pathophysiology and treatment of the resultant liver injury.
Disclosures: Dhineshreddy Gurala indicated no relevant financial relationships. Hassan Almoussawi indicated no relevant financial relationships. Jobin Philipose indicated no relevant financial relationships. Jeffrey Abergel indicated no relevant financial relationships.