A case of secondary sclerosing cholangitis due to COVID-19

Tafreshi, Shima; Whiteside, Ian; Levine, Irving; D’Agostino, Catherine

doi:10.1016/j.clinimag.2021.07.017

Cited by 27 publications

(76 citation statements)

References 20 publications

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“…In our cohort we could observe a predominance of male patients. This appears to be in line with other published reports on COVID-19-associated SSC [ 6 , 10 , 11 , 13 , 50 ]. Furthermore, male gender is a known risk factor for the development of severe COVID-19 [ 51 ].…”

Section: Discussionsupporting

confidence: 93%

“…While clinical reports have increasingly identified hepatobiliary manifestations of COVID-19, their radiological manifestations are largely unknown and underreported. The current data on COVID-19-associated hepatobiliary manifestations mainly stems from case reports from the gastroenterological literature and detailed description of their imaging manifestations is lacking [ 6 , 10 , 21 , 22 ]. Specifically, development of SSC in COVID-19 patients has been described only recently and is akin to SSC-CIP of other causes, presenting as a delayed extrapulmonary COVID-19 manifestation characterized by progressive cholestatic liver injury with high risk of rapid progression to biliary cirrhosis [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…Affected patients develop progressive cholestasis and are at high risk of rapidly progressing to biliary cirrhosis requiring liver transplantation [6,8,9]. Several case reports and few case series have described the clinical features of this entity [6,[10][11][12][13][14], however, the MRI features have not yet been described in detail.…”

Section: Introductionmentioning

confidence: 99%

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Imaging features of COVID-19-associated secondary sclerosing cholangitis on magnetic resonance cholangiopancreatography: a retrospective analysis

et al. 2022

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Background Despite emerging reports of secondary sclerosing cholangitis (SSC) in critically ill COVID-19 patients little is known about its imaging findings. It presents as delayed progressive cholestatic liver injury with risk of progression to cirrhosis. Diagnosis cannot be made based on clinical presentation and laboratory markers alone. Magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography (MRCP) can aid in the diagnosis. The aim of this study was to describe MRI/MRCP imaging features of COVID-19-associated SSC. Results Seventeen patients (mean age 60.5 years, 15 male) who underwent MRI/MRCP were included. All had been admitted to intensive care unit (ICU) (median duration of ICU stay 10 weeks, range, 2–28 weeks) and developed acute respiratory distress syndrome requiring mechanical ventilation. On imaging, all patients had intrahepatic bile duct strictures and 10 (58.8%) had associated upstream dilatation. Intrahepatic bile duct beading was seen in 14 cases (82.3%). Only one patient (5.9%) had extrahepatic bile duct stricturing. Patchy arterial phase hyperenhancement and high signal on T2- and diffusion-weighted images were seen in 7 cases (53.8%) and 9 cases (52.9%), respectively. Biliary casts were seen in 2 cases (11.8%). Periportal lymphadenopathy and vascular complications were not seen. Conclusion On MRI/MRCP, COVID-19-associated SSC presents with multiple intrahepatic bile duct strictures with or without upstream dilatation and intrahepatic bile duct beading. Surrounding hepatic parenchymal changes including alterations in enhancement and T2 signal are common. The extrahepatic biliary tree was typically spared and periportal lymphadenopathy was missing in all patients.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

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Imaging features of COVID-19-associated secondary sclerosing cholangitis on magnetic resonance cholangiopancreatography: a retrospective analysis

et al. 2022

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“…The most common findings were centrilobular congestion and steatosis that was associated with preexistent obesity and diabetes mellitus. Additional findings described in adults were hepatocyte necrosis, mild to moderate lymphocytic infiltrate in the periportal zone, cholestasis with canalicular bile plugs, ductular reaction, and nuclear pleomorphism of cholangiocytes (8–15,19). In contrast to adult cohorts, in our pediatric cohort, there was no steatosis.…”

Section: Discussionmentioning

confidence: 79%

“…Specifically, findings were significant for hepatomegaly, dilated biliary ducts, periportal edema, or gallbladder wall edema and thickening. In adults, ultrasound findings are mostly significant for focal strictures of intrahepatic bile ducts, with intraluminal sludge and casts, compatible with the radiological hallmark of SSC (8–15,19).…”

Section: Discussionmentioning

confidence: 98%

Long COVID-19 Liver Manifestation in Children

Cooper

Tobar

Konen

et al. 2022

Journal of Pediatric Gastroenterology &Amp; Nutrition

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Objectives: Severe acute respiratory syndrome coronavirus 2 , the novel coronavirus responsible for coronavirus disease (COVID-19), has been a major cause of morbidity and mortality worldwide. Gastrointestinal and hepatic manifestations during acute disease have been reported extensively in the literature. Post-COVID-19 cholangiopathy has been increasingly reported in adults. In children, data are sparse. Our aim was to describe pediatric patients who recovered from COVID-19 and later presented with liver injury. Methods: This is a retrospective case series study of pediatric patients with post-COVID-19 liver manifestations. We collected data on demographics, medical history, clinical presentation, laboratory results, imaging, histology, treatment, and outcome. Results: We report 5 pediatric patients who recovered from COVID-19 and later presented with liver injury. Two types of clinical presentation were distinguishable. Two infants aged 3 and 5 months, previously healthy, presented with acute liver failure that rapidly progressed to liver transplantation. Their liver explant showed massive necrosis with cholangiolar proliferation and lymphocytic infiltrate. Three children, 2 aged 8 years and 1 aged 13 years, presented with hepatitis with cholestasis. Two children had a liver biopsy significant for lymphocytic portal and parenchyma inflammation, along with bile duct proliferations. All 3 were started on steroid treatment; liver enzymes improved, and they were weaned successfully from treatment. For all 5 patients, extensive etiology workup for infectious and metabolic etiologies was negative. Conclusions: We report 2 distinct patterns of potentially long COVID-19 liver manifestations in children with common clinical, radiological, and histopathological characteristics after a thorough workup excluded other known etiologies.

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Secondary sclerosing cholangitis after COVID-19 pneumonia: a report of two cases and review of the literature

Bauer

Pavlova

Abbassi

et al. 2022

Clin J Gastroenterol

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Secondary sclerosing cholangitis in critically ill patients (SC-CIP) is a rare disease characterized by chronic cholestasis. The underlying pathophysiology of SC-CIP is not fully understood, and prognosis in severe cases remains poor with liver transplantation remaining the only curative treatment option. There is a growing amount of literature describing patients with chronic cholangiopathy after COVID-19 infection. The vast majority of the patients described in these reports were male and had a poor outcome. While the exact percentage of patients with COVID-19-related SC-CIP cannot be estimated accurately due to a lack of larger studies, an increase in patients with long-term complications of chronic cholestatic liver disease after severe COVID19-pneumonia can be expected in the upcoming years. Treatment options remain limited and further research is needed to improve the dismal prognosis of SC-CIP. Here, we present the cases of two patients who developed SC-CIP after prolonged intensive care unit stay due to severe COVID-19 pneumonia. Both patients required invasive ventilation for 31 and 141 days, respectively, as well as extra-corporal membrane oxygenation for 23 and 87 days. The patients suffered from jaundice and severe pruritus, and typical features of SC-CIP were present by MRCP and ERC. Repeated removal of biliary casts resulted in some alleviation of their clinical symptoms, but cholestasis parameters remain elevated. Furthermore, an increased liver stiffness was indicative of advanced fibrosis in both patients. In addition to these two case reports, we provide a concise review of the literature of SC-CIP after COVID-19 infection and discuss risk factors, treatment options and prognosis.

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A case of secondary sclerosing cholangitis due to COVID-19

Cited by 27 publications

References 20 publications

Imaging features of COVID-19-associated secondary sclerosing cholangitis on magnetic resonance cholangiopancreatography: a retrospective analysis

Imaging features of COVID-19-associated secondary sclerosing cholangitis on magnetic resonance cholangiopancreatography: a retrospective analysis

Long COVID-19 Liver Manifestation in Children

Secondary sclerosing cholangitis after COVID-19 pneumonia: a report of two cases and review of the literature

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