Colangitis esclerosante secundaria: una complicación tras la infección severa por COVID-19

Vega, Nazaret María Pizarro; López-Fando, P. Valer; Gómez, Gema de la Poza; Alcol, Belén Piqueras; Santana, Marina Gil; Fuentes, Paloma Ruiz; Amado, Marcos Alfredo Rodríguez; José, Fernando Bermejo San

doi:10.1016/j.gastrohep.2022.04.003

Cited by 6 publications

(4 citation statements)

References 7 publications

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“…In the six cases reported by Vega et al, 1 none of the patients underwent an ERCP. In our clinical experience with the Gamma variant in Southern Brazil, we have treated many cases of this novel entity, every one of them with the same choledochal cast removed via ERCP.…”

mentioning

confidence: 89%

“…We have read with great interest the scientific letter of Vega et al, 1 which describes six cases of the novel clinical entity named post-COVID 19 cholangiopathy. This is the name given to the secondary sclerosing cholangitis following a severe COVID-19 infection, 2 as per first reported in two seminal papers comprised of 15 cases published in 2021 in the American Journal of Gastroenterology.…”

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confidence: 99%

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Billiary casts in post-COVID-19 cholangiopathy

Soldera

Balbinot

2023

Gastroenterología y Hepatología (English Edition)

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confidence: 89%

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confidence: 99%

Billiary casts in post-COVID-19 cholangiopathy

Soldera

Balbinot

2023

Gastroenterología y Hepatología (English Edition)

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“…Interestingly, these patients did not return to normal levels in their liver laboratory parameters, and three of them even developed portal hypertension, one of them experiencing decompensation. These complications strongly suggest the presence of COVID-19-related SSC in these patients[ 81 ].…”

Section: Biliary Tract Injury and Sclerosing Cholangitis As A Long-te...mentioning

confidence: 99%

Histopathological impact of SARS-CoV-2 on the liver: Cellular damage and long-term complications

Rodriguez-Espada,

Salgado-de la Mora,

Rodriguez-Paniagua

et al. 2024

World J Gastroenterol

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Coronavirus disease 2019 (COVID-19), caused by the highly pathogenic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), primarily impacts the respiratory tract and can lead to severe outcomes such as acute respiratory distress syndrome, multiple organ failure, and death. Despite extensive studies on the pathogenicity of SARS-CoV-2, its impact on the hepatobiliary system remains unclear. While liver injury is commonly indicated by reduced albumin and elevated bilirubin and transaminase levels, the exact source of this damage is not fully understood. Proposed mechanisms for injury include direct cytotoxicity, collateral damage from inflammation, drug-induced liver injury, and ischemia/hypoxia. However, evidence often relies on blood tests with liver enzyme abnormalities. In this comprehensive review, we focused solely on the different histopathological manifestations of liver injury in COVID-19 patients, drawing from liver biopsies, complete autopsies, and in vitro liver analyses. We present evidence of the direct impact of SARS-CoV-2 on the liver, substantiated by in vitro observations of viral entry mechanisms and the actual presence of viral particles in liver samples resulting in a variety of cellular changes, including mitochondrial swelling, endoplasmic reticulum dilatation, and hepatocyte apoptosis. Additionally, we describe the diverse liver pathology observed during COVID-19 infection, encompassing necrosis, steatosis, cholestasis, and lobular inflammation. We also discuss the emergence of long-term complications, notably COVID-19-related secondary sclerosing cholangitis. Recognizing the histopathological liver changes occurring during COVID-19 infection is pivotal for improving patient recovery and guiding decision-making.

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“…Post-COVID-19 liver disease includes manifestations such as elevated transaminase levels, hypoalbuminemia and prolonged prothrombin time, which are the result of the cytopathic action of the virus (3)(4)(5)(6). Secondary sclerosing cholangitis in critically ill patients (SSC-CIP) is a rare entity, with a prevalence of 0.05% in patients requiring hospitalization in the intensive care unit (ICU) (7) and as high as 12% in patients with severe COVID-19 (7)(8)(9)(10). This may be explained by the fact that, apart from the already known effects associated with SSC-CIP (requirement of invasive mechanical ventilation and vasopressors, shock, and sepsis), these patients experience direct damage to the cholangiocyte endothelium, which is facilitated by the high expression of angiotensin-converting enzyme receptors (ACE-2) in the cholangiocytes (8,11).…”

Section: Introductionmentioning

confidence: 99%

Colangitis esclerosante secundaria tras COVID-19 grave. Reporte de caso

Pantoja-Rosero,

Rivera-Martínez,

Gómez-Ramírez

et al. 2023

Case reports

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Resumen Introducción. La colangiopatía tras COVID-19 grave es una patología hepática descrita recientemente; esta se atribuye a factores adicionales a los ya descritos en la colangitis esclerosante secundaria en pacientes críticamente enfermos (CES-PCE), en la que el alto requerimiento de fármacos vasoactivos y de ventilación con presión positiva al final de la espiración conlleva a una mayor prevalencia y severidad. Presentación del caso. Mujer de 55 años quien acudió al servicio de urgencias de una clínica de III nivel de complejidad de Cali, Colombia, por cuadro clínico consistente en anosmia, diarrea, fiebre (39°C), tos seca y disnea progresiva. La paciente, que fue diagnosticada con COVID-19 y requirió soporte ventilatorio, vasopresor y hemodinámico en la unidad de cuidados intensivos, tuvo sobreinfección bacteriana y estancia hospitalaria prolongada. Al día 24 de hospitalización presentó ictericia en mucosas y escleras, así como elevación de los niveles de bilirrubinas, fosfatasa alcalina y γ-glutamiltranferasa. Se le realizó una colangiorresonancia y una biopsia hepática que evidenciaron hallazgos compatibles con colangitis esclerosante, por lo que se le dio un manejo conservador con vigilancia y observación. Luego del alta tuvo mejoría de su compromiso hepático e infeccioso y continuó con hemodiálisis ambulatoria. Conclusiones. La colangiopatía esclerosante secundaria tras COVID-19 grave es multifactorial e inusual, por tanto es necesario incluir al SARS-Cov-2 como etiología a descartar en pacientes con síntomas relacionados para así instaurar un manejo temprano y disminuir la morbilidad hepática.

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Colangitis esclerosante secundaria: una complicación tras la infección severa por COVID-19

Cited by 6 publications

References 7 publications

Billiary casts in post-COVID-19 cholangiopathy

Billiary casts in post-COVID-19 cholangiopathy

Histopathological impact of SARS-CoV-2 on the liver: Cellular damage and long-term complications

Colangitis esclerosante secundaria tras COVID-19 grave. Reporte de caso

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