Severe acute respiratory syndrome coronavirus-2-associated cholangiopathies

Abstract

Purpose of review SARS-CoV2 is a b-coronavirus, isolated for the first time in Wuhan in December 2019. Bilateral interstitial pneumonia is the hallmark of this disease. Liver is the second viral target for frequency and AST and ALT elevation is a common finding. From February 2020, two different cholangiopathies have been reported in COVID-19 patients. The aim of this article is to review the cases so far described in order to share information and awareness about these new clinical entities.Recent findings SARS-CoV2 seems to trigger autoimmunity and two cases of primary biliary cholangitis (PBC) have been developed after viral infection while more than 30 patients have showed a rapidly progressing cholangiopathy with features of secondary sclerosing cholangitis (SSC). For what concerns SSC pathogenesis, a theory combining multiple hits is the most recognized. SummaryTwo different cholangiopathies have been reported in patients after severe-COVID-19. Attention should be paid to the development of cholestasis in ICU setting but above all after discharge and liver function tests should be, therefore, periodically performed. No treatment strategies are available and liver transplantation remains the last option in individuals with liver failure because of SSC. Other efforts are necessary to better understand the pathogenesis and to expand therapeutic options. Keywords cholangiopathy, coronavirus disease 2019, primary biliary cholangitis, secondary sclerosing cholangitis LIVER DISEASE IN CORONAVIRUS DISEASE 2019During COVID-19 hospitalization, a variable percentage of patients, ranging from 14 to 76%, develops transaminase alterations with a greater

Early detection of COVID-19 cholangiopathy using cholangioscopy—a case report of two critically ill patients

“…Recently, cholangiopathy in patients with severe COVID-19 infection has been described as a new entity [ 4 , 5 , 7 ]. Providing unique histological features, so-called COVID-associated cholangiopathy or post-COVID cholangiopathy has to be differentiated from secondary sclerosing cholangitis in critically ill patients (SSC-CIP) [ 7 , 8 ].…”

“…Impaired liver function tests and liver injury are described, ranging from mild to severe [ 3 ]. More serious hepatic affections with cholangiopathy, liver failure, and development into secondary biliary cirrhosis have been described recently as a complication of severe COVID-19 infection occurring several months after initial diagnosis [ 4 , 5 ]. Cholangiocytes express angiotensin-converting enzyme 2 (ACE) receptor, which may be seen as the hepatic entry point of the virus [ 6 ].…”

Profile of Liver Cholestatic Biomarkers Following Prolonged Ketamine Administration in Patients With Covid-19

“…For exemple, hydroxychloroquine, lopinavir/ritonavir, remdesivir and tocelizumab were associated with the risk to develop abnormal liver transaminases during hospitalization, while no association was found with total bilirubin or alkaline phosphatase [12] . At least, two types of cholangiopathies have been associated with SARS-CoV-2 [13] . The rst form has probably an autoimmune origin resembling primary biliary cholangitis (PBC), while the second has the characteristics of a secondary sclerosing cholangitis (SSC) [14][15][16][17][18][19][20][21] .…”

COVID-19-associated secondary sclerosing cholangitis – A case series of 4 patients

“…Until now, about 30 cases of this severe cholestatic liver disease have been described in the literature [ 2 , 3 ]. Common reported features were severe COVID-19 pneumonia requiring long intensive care unit (ICU) stay, invasive mechanical ventilation (IMV) with high positive-end expiratory pressure (PEEP), periods of prone position, circulatory support with vasopressors and administration of multiple other drugs.…”