Severe Hepatitis in Pediatric Coronavirus Disease 2019

Antala, Swati; Diamond, Tamir; Kociolek, Larry K.; Shah, Ankur; Chapin, Catherine A.

doi:10.1097/mpg.0000000000003404

Cited by 31 publications

(50 citation statements)

References 22 publications

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“…Sgouropoulou et al reported a 5-year-old pediatric patient who presented with transient acute hepatitis after SARS-CoV-2 infection (17). Antala et al described a 6-month-old infant who presented with acute liver failure as a subacute presentation of COVID-19 disease (7). On admission he tested positive for SARS-CoV-2 PCR.…”

Section: Discussionmentioning

confidence: 99%

“…In children and adolescents, COVID-19 is generally mild (3); however, multisystem inflammatory syndrome (MIS-C) is a serious possible consequence (4). in this age group, liver involvement was described with acute COVID-19 and with MIS-C. Mostly, transaminases were elevated, without hepatic synthetic dysfunction, though acute liver failure was also reported (5)(6)(7). Children who developed elevated alanine aminotransferase were at risk of a more severe disease course, including longer hospitalization and stay in the intensive care unit (ICU).…”

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confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Long COVID-19 Liver Manifestation in Children

Cooper

Tobar

Konen

et al. 2022

Journal of Pediatric Gastroenterology &Amp; Nutrition

View full text Add to dashboard Cite

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“…A liver biopsy could not be performed, as the patient was unstable and hypo-coagulable, however, an exhaustive workup for other causes of ALF was negative. Considering recent case reports showing COVID-19 infection as a direct cause of acute hepatitis in children [ 5 ], our case report emphasizes the importance of further research into the possible association between COVID-19 and isolated ALF.…”

Section: Discussionmentioning

confidence: 65%

“…A usual clinical course of COVID-19 infection involves upper respiratory infection, fever, chills, and anosmia, followed by viral pneumonia, severe acute respiratory distress syndrome, and multiorgan failure [ 3 ]. Recently, there have been few case reports of COVID-19 infection in children presenting as severe acute hepatitis [ 5 ]. Our report describes a case of an adult woman presenting with severe ALF as her only presenting sign and symptom of COVID-19 infection.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 Infection Presenting as an Isolated Severe Acute Liver Failure

Khawaja¹,

Bawa²,

Omer³

et al. 2022

Cureus

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The clinical features of severe acute respiratory syndrome-coronavirus disease 2019 (SARS-COVID-19) infection range from mild upper respiratory symptoms to severe acute respiratory failure. Among other less common features are diarrhea, nausea, vomiting, elevated liver enzymes, and acute kidney injury. We present a case of a 49-year-old female with no preexisting liver disease who presented with weakness and dizziness for one week. Initial investigations revealed acute liver failure (ALF) and positive COVID-19 on polymerase chain reaction (PCR) testing. The patient did not have any upper or lower respiratory symptoms, and extensive workup to look for other etiologies of acute liver failure was unremarkable. She eventually deteriorated to decompensated liver failure and was transitioned to comfort measures only. Liver injury is a well-documented phenomenon associated with COVID-19 infection. Some of the common pathophysiological mechanisms include direct liver injury, immune-mediated liver damage due to the severe inflammatory response, ischemic injury, endothelial disruption, and coagulopathy. Our case uniquely highlights that SARS-COVID-19 infection may have the potential to solely affect hepatocytes without the classic severe acute respiratory distress syndrome. This case demonstrates that a diagnosis of COVID-19 may be considered if no other etiology of ALF is identified.

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“…In contrast to rarely impaired pulmonary function, respiratory system symptoms persist in approximately 30% of patients at 3 months after SARS‐CoV‐2 infection 9 . Compared with adults, severe hepatitis could be a critical concern for a long‐term follow‐up in children with COVID‐19 10 . Consistently, Brodin et al.…”

Section: The Long‐term Impaired Organ Function In Children With Sars‐...mentioning

confidence: 78%

Focusing on the long‐term recovery of severe acute respiratory syndrome coronavirus 2 infection: Clinically relevant observations

Wang

Zhang

2022

Clinical and Translational Dis

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Background The long‐term implications of COVID‐19 attract global attention in the post‐COVID‐19 pandemic era. Impaired lung function is the main sequelae in adults' survivors of SARS‐CoV‐2 infection. Methods and Results The plasma proteomic pattern provides novel evidence on multiple biological domains relevant to monitoring lung function and targeting the clinical application in adults with acute respiratory distress syndrome (ARDS) secondary to SARS‐CoV‐2 infection (SARS‐CoV‐2‐ARDS). Preliminary studies support the evidence of pulmonary function tests (PFT) and computed tomography (CT) scan as routine follow‐up tools. Combining the early fibrotic indicators and D‐dimer levels could prove the validity and reliability of the proactive management of lung function assessment during the long‐term recovery in SARS‐CoV‐2 infection. Conclusion In summary, protocolized PFT and CT scan and effective biomarkers for early fibrotic changes should be applied to clinical practice during the long follow‐up in patients with severe COVID‐19.

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Severe Hepatitis in Pediatric Coronavirus Disease 2019

Cited by 31 publications

References 22 publications

Long COVID-19 Liver Manifestation in Children

Long COVID-19 Liver Manifestation in Children

COVID-19 Infection Presenting as an Isolated Severe Acute Liver Failure

Focusing on the long‐term recovery of severe acute respiratory syndrome coronavirus 2 infection: Clinically relevant observations

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