Liver Pathology and SARS-CoV-2 Detection in Formalin-Fixed Tissue of Patients With COVID-19

Abstract

Objectives The novel coronavirus, severe acute respiratory syndrome coronavirus 2, causing coronavirus disease 2019 (COVID-19) remains a global health threat and a significant source of human morbidity and mortality. While the virus primarily induces lung injury, it also has been reported to cause hepatic sequelae. Methods We aimed to detect the virus in formalin-fixed tissue blocks and document the liver injury patterns in patients with COVID-19 compared with a control group. Results We were able to detect viral RNA in the bronchioalveolar cell blocks (12/12, 100%) and formalin-fixed, paraffin-embedded tissue of the lung (8/8, 100%) and liver (4/9, 44%) of patients with COVID-19. Although the peak values of the main liver enzymes and bilirubin were higher in the patients with COVID-19 compared with the control group, the differences were not significant. The main histologic findings were minimal to focal mild portal tract chronic inflammation (7/8, 88%, P < .05) and mild focal lobular activity (6/8, 75%, P = .06). Conclusions We found that most patients who died of COVID-19 had evidence of mild focal hepatitis clinically and histologically; however, the virus was detected in less than half of the cases.

Correlation Between Clinical and Pathological Findings of Liver Injury in 27 Patients With Lethal COVID‐19 Infections in Brazil

“…A number of studies have examined the histopathological effects of COVID‐19 on the respiratory tract, but few have specifically examined the impact on the liver, ( 9 , 10 ) in part because of limited tissue availability. Much of the existing literature is based on reports of small case series, ( 11 , 12 ) although a few larger case series have been published as well.…”

The histologic and molecular correlates of liver disease in fatal COVID-19 including with alcohol use disorder

“…Liver disease is a well-documented and common problem in severe COVID-19 [5] , [6] , [7] , [8] . Pathologic changes in the liver ascribed to SARS-CoV2 include portal tract/lobular inflammation, microvascular thrombi, and hepatocyte necrosis [6] , [7] , [8] .…”

“…Liver disease is a well-documented and common problem in severe COVID-19 [5] , [6] , [7] , [8] . Pathologic changes in the liver ascribed to SARS-CoV2 include portal tract/lobular inflammation, microvascular thrombi, and hepatocyte necrosis [6] , [7] , [8] . However, several studies have indicated that SARS-CoV2 RNA is either not detectable or present in a minority of COVID-19 related hepatitis cases [6] , [8] , [9] though abundant in the lung [9] , [10] , [11] , [12] .…”

Unraveling the role of liver sinusoidal endothelial cells in COVID-19 liver injury

“…ACE2 and TMPRSS2, the 2 major viral cell entry factors, are expressed at only low levels in hepatocytes and non-parenchymal cells. 3,5 Even though SARS-CoV2 RNA has been detected in the livers of COVID-19 patients, 6 functional studies demonstrating robust SARS-CoV2 infection of liver cells are pending. 3 Histopathological studies of COVID-19 livers reported an increased prevalence of moderate steatosis, mild lobular and portal inflammation, and sinusoidal thrombosis.…”

“…ACE2 and TMPRSS2, the two major viral cell entry factors, are expressed at only low levels in hepatocytes and non-parenchymal cells [ 3 , 5 ]. Even though SARS-CoV2 RNA has been detected in the livers of COVID-19 patients [ 6 ], functional studies demonstrating robust SARS-CoV2 infection of liver cells are pending [ 3 ].…”