INTRODUCTION: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 virus, is a predominantly respiratory tract infection with the capacity to affect multiple organ systems. Abnormal liver tests, mainly transaminase elevations, have been reported in hospitalized patients. We describe a syndrome of cholangiopathy in patients recovering from severe COVID-19 characterized by marked elevation in serum alkaline phosphatase (ALP) accompanied by evidence of bile duct injury on imaging. METHODS: We conducted a retrospective study of COVID-19 patients admitted to our institution from March 1, 2020, to August 15, 2020, on whom the hepatology service was consulted for abnormal liver tests. Bile duct injury was identified by abnormal liver tests with serum ALP > 3x upper limit of normal and abnormal findings on magnetic resonance cholangiopacreatography. Clinical, laboratory, radiological, and histological findings were recorded in a Research Electronic Data Capture database. RESULTS: Twelve patients were identified, 11 men and 1 woman, with a mean age of 58 years. Mean time from COVID-19 diagnosis to diagnosis of cholangiopathy was 118 days. Peak median serum alanine aminotransferase was 661 U/L and peak median serum ALP was 1855 U/L. Marked elevations of erythrocyte sedimentation rate, C-reactive protein, and D-dimers were common. Magnetic resonance cholangiopacreatography findings included beading of intrahepatic ducts (11/12, 92%), bile duct wall thickening with enhancement (7/12, 58%), and peribiliary diffusion high signal (10/12, 83%). Liver biopsy in 4 patients showed acute and/or chronic large duct obstruction without clear bile duct loss. Progressive biliary tract damage has been demonstrated radiographically. Five patients were referred for consideration of liver transplantation after experiencing persistent jaundice, hepatic insufficiency, and/or recurrent bacterial cholangitis. One patient underwent successful living donor liver transplantation. DISCUSSION: Cholangiopathy is a late complication of severe COVID-19 with the potential for progressive biliary injury and liver failure. Further studies are required to understand pathogenesis, natural history, and therapeutic interventions.
INTRODUCTION: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 virus, is a predominantly respiratory tract infection with the capacity to affect multiple organ systems. Abnormal liver tests, mainly transaminase elevations, have been reported in hospitalized patients. We describe a syndrome of cholangiopathy in patients recovering from severe COVID-19 characterized by marked elevation in serum alkaline phosphatase (ALP) accompanied by evidence of bile duct injury on imaging. METHODS: We conducted a retrospective study of COVID-19 patients admitted to our institution from March 1, 2020, to August 15, 2020, on whom the hepatology service was consulted for abnormal liver tests. Bile duct injury was identified by abnormal liver tests with serum ALP > 3x upper limit of normal and abnormal findings on magnetic resonance cholangiopacreatography. Clinical, laboratory, radiological, and histological findings were recorded in a Research Electronic Data Capture database. RESULTS: Twelve patients were identified, 11 men and 1 woman, with a mean age of 58 years. Mean time from COVID-19 diagnosis to diagnosis of cholangiopathy was 118 days. Peak median serum alanine aminotransferase was 661 U/L and peak median serum ALP was 1855 U/L. Marked elevations of erythrocyte sedimentation rate, C-reactive protein, and D-dimers were common. Magnetic resonance cholangiopacreatography findings included beading of intrahepatic ducts (11/12, 92%), bile duct wall thickening with enhancement (7/12, 58%), and peribiliary diffusion high signal (10/12, 83%). Liver biopsy in 4 patients showed acute and/or chronic large duct obstruction without clear bile duct loss. Progressive biliary tract damage has been demonstrated radiographically. Five patients were referred for consideration of liver transplantation after experiencing persistent jaundice, hepatic insufficiency, and/or recurrent bacterial cholangitis. One patient underwent successful living donor liver transplantation. DISCUSSION: Cholangiopathy is a late complication of severe COVID-19 with the potential for progressive biliary injury and liver failure. Further studies are required to understand pathogenesis, natural history, and therapeutic interventions.
Authors: Thomas Marjot; Christiane S Eberhardt; Tobias Boettler; Luca S Belli; Marina Berenguer; Maria Buti; Rajiv Jalan; Mario U Mondelli; Richard Moreau; Daniel Shouval; Thomas Berg; Markus Cornberg Journal: J Hepatol Date: 2022-07-20 Impact factor: 30.083
Authors: Nazaret María Pizarro Vega; Paz Valer Lopez-Fando; Gema de la Poza Gómez; Belén Piqueras Alcol; Marina Gil Santana; Paloma Ruiz Fuentes; Marcos Alfredo Rodríguez Amado; Fernando Bermejo San José Journal: Gastroenterol Hepatol Date: 2022-05-13 Impact factor: 5.867
Authors: Danny Jonigk; Christopher Werlein; Saskia von Stillfried; Peter Boor; Till Acker; Martin Aepfelbacher; Kerstin U Amann; Gustavo Baretton; Peter Barth; Rainer M Bohle; Andreas Büttner; Reinhard Büttner; Reinhard Dettmeyer; Philip Eichhorn; Sefer Elezkurtaj; Irene Esposito; Katja Evert; Matthias Evert; Falko Fend; Nikolaus Gaßler; Stefan Gattenlöhner; Markus Glatzel; Heike Göbel; Elise Gradhand; Torsten Hansen; Arndt Hartmann; Axel Heinemann; Frank L Heppner; Julia Hilsenbeck; David Horst; Jan C Kamp; Gita Mall; Bruno Märkl; Benjamin Ondruschka; Jessica Pablik; Susanne Pfefferle; Alexander Quaas; Helena Radbruch; Christoph Röcken; Andreas Rosenwald; Wilfried Roth; Martina Rudelius; Peter Schirmacher; Julia Slotta-Huspenina; Kevin Smith; Linna Sommer; Konrad Stock; Philipp Ströbel; Stephanie Strobl; Ulf Titze; Gregor Weirich; Joachim Weis; Martin Werner; Claudia Wickenhauser; Thorsten Wiech; Peter Wild; Tobias Welte Journal: Virchows Arch Date: 2022-04-01 Impact factor: 4.535