Spontaneous Intraparenchymal Hepatic Hemorrhage as a Sequela of COVID-19

Daid, Sarav; Toribio, Adderly; Lakshmanan, Seetha; Sadda, Ayad

doi:10.7759/cureus.10447

Cited by 5 publications

(8 citation statements)

References 12 publications

(14 reference statements)

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“…However, administration of NAC alone did not worsen haemorrhagic stroke outcome, suggesting that NAC exerts thrombolytic effects without significantly impairing normal hemostasis [ 168 ]. Daid et al successfully treated a COVID-19 patient with intrahepatic haemorrhage with the application of IV NAC [ 180 ].…”

Section: Nac As a Therapeutic Agentmentioning

confidence: 99%

N-Acetylcysteine and Other Sulfur-Donors as a Preventative and Adjunct Therapy for COVID-19

Preez

Aldous

Kruger

et al. 2022

Advances in Pharmacological and Pharmaceutical Sciences

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The airway epithelial glycocalyx plays an important role in preventing severe acute respiratory syndrome coronavirus 2 entry into the epithelial cells, while the endothelial glycocalyx contributes to vascular permeability and tone, as well as modulating immune, inflammatory, and coagulation responses. With ample evidence in the scientific literature that coronavirus disease 2019 (COVID-19) is related to epithelial and endothelial dysfunction, preserving the glycocalyx should be the main focus of any COVID-19 treatment protocol. The most studied functional unit of the glycocalyx is the glycosaminoglycan heparan sulfate, where the degree and position of the sulfate groups determine the biological activity. N-acetylcysteine (NAC) and other sulfur donors contribute to the inorganic sulfate pool, the rate-limiting molecule in sulfation. NAC is not only a precursor to glutathione but also converts to hydrogen sulfide, inorganic sulfate, taurine, Coenzyme A, and albumin. By optimising inorganic sulfate availability, and therefore sulfation, it is proposed that COVID-19 can be prevented or at least most of the symptoms attenuated. A comprehensive COVID-19 treatment protocol is needed to preserve the glycocalyx in both the prevention and treatment of COVID-19. The use of NAC at a dosage of 600 mg bid for the prevention of COVID-19 is proposed, but a higher dosage of NAC (1200 mg bid) should be administered upon the first onset of symptoms. In the severe to critically ill, it is advised that IV NAC should be administered immediately upon hospital admission, and in the late stage of the disease, IV sodium thiosulfate should be considered. Doxycycline as a protease inhibitor will prevent shedding and further degradation of the glycocalyx.

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Section: Nac As a Therapeutic Agentmentioning

confidence: 99%

N-Acetylcysteine and Other Sulfur-Donors as a Preventative and Adjunct Therapy for COVID-19

Preez

Aldous

Kruger

et al. 2022

Advances in Pharmacological and Pharmaceutical Sciences

View full text Add to dashboard Cite

show abstract

“…Various clinical disorders can cause these hematomas, and these include hepatic adenomas, hepatocellular tumours, amyloidosis, systemic lupus erythematosus and warfarin therapy. The pathogenesis involves compromised integrity of the hepatic parenchyma and vasculature 5. This case study suggests that COVID-19 infection can cause hepatic injury.…”

Section: Discussionmentioning

confidence: 81%

“…The pathogenesis involves compromised integrity of the hepatic parenchyma and vasculature. 5 This case study suggests that COVID-19 infection can cause hepatic injury. The pathogenesis is likely multifactorial and includes virus-induced hepatic cytopathy and apoptosis, elevated inflammatory cytokines leading to vascular damage and microthrombosis and possibly alterations hepatic blood flow resulting in ischemia and/or vascular congestion.…”

Section: Discussionmentioning

confidence: 83%

“…The incidence of spontaneous hepatic hematoma is low, accounting for only 1% of admissions to specialist liver units. 5 Various clinical disorders can cause these hematomas, and these include hepatic adenomas, hepatocellular tumours, amyloidosis, systemic lupus erythematosus and warfarin therapy. The pathogenesis involves compromised integrity of the hepatic parenchyma and vasculature.…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of spontaneous hepatic hematoma is low, accounting for only 1% of admissions to specialist liver units. 5 Various clinical disorders can cause these hematomas, and these…”

Section: Case Reportmentioning

confidence: 99%

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Spontaneous large liver haematoma with extensive intraperitoneal bleeding in a patient with COVID-19 infection

2022

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Thrombotic complications during COVID-19 infections occur frequently, and anticoagulants to prevent and treat deep vein thrombosis appear to have a good safety profile in these patients. In addition, haemorrhagic complications during COVID-19 infections have also been reported. Hepatic inflammation can occur in COVID-19 infections as a direct consequence of cellular infection and cytopathy. Spontaneous subcapsular hepatic haematoma is extremely rare and can be life-threatening.A woman in her 40s presented to the hospital with fever and shortness of breath and was diagnosed with COVID-19 infection with respiratory failure requiring intubation. On day 49 of hospitalisation, she developed melena and acute anaemia; her haemoglobin dropped from 97g/L (9.7g/dL) to 56g/L (5.6g/dL). Abdominal and pelvic CT scans showed a large subcapsular liver haematoma with retroperitoneal extension. The patient received blood transfusions and remained haemodynamically stable. She was eventually extubated and discharged home.

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Evaluation of the efficacy and safety of oral N‐acetylcysteine in patients with COVID‐19 receiving the routine antiviral and hydroxychloroquine protocol: A randomized controlled clinical trial

Atefi,

Goodarzi,

Riahi

et al. 2023

Immunity Inflam & Disease

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BackgroundThe current absence of gold‐standard or all‐aspect favorable therapies for COVID‐19 renders a focus on multipotential drugs proposed to prevent or treat this infection or ameliorate its signs and symptoms vitally important. The present well‐designed randomized controlled trial (RCT) sought to evaluate the efficacy and safety of N‐acetylcysteine (NAC) as adjuvant therapy for 60 hospitalized Iranian patients with COVID‐19.MethodsTwo 30‐person diets, comprising 15 single diets of Kaletra (lopinavir/ritonavir) + hydroxychloroquine (HCQ) with/without NAC (600 mg TDS) and atazanavir/ritonavir + HCQ with/without NAC (600 mg TDS), were administered in the study.ResultsAt the end of the study, a further decrease in C‐reactive protein was observed in the NAC group (P = 0.008), and no death occurred in the atazanavir/ritonavir + HCQ + NAC group, showing that the combination of these drugs may reduce mortality. The atazanavir/ritonavir + HCQ and atazanavir/ritonavir + NAC groups exhibited the highest O2 saturation at the end of the study and a significant rise in O2 saturation following intervention commencement, including NAC (P > 0.05). Accordingly, oral or intravenous NAC, if indicated, may enhance O2 saturation, blunt the inflammation trend (by reducing C‐reactive protein), and lower mortality in hospitalized patients with COVID‐19.ConclusionThe NAC could be more effective as prophylactic or adjuvant therapy in stable non‐severe cases of COVID‐19 with a particularly positive role in the augmentation of O2 saturation and faster reduction of the CRP level and inflammation or could be effective for better controlling of COVID‐19 or its therapy‐related side effects.

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Spontaneous Intraparenchymal Hepatic Hemorrhage as a Sequela of COVID-19

Cited by 5 publications

References 12 publications

N-Acetylcysteine and Other Sulfur-Donors as a Preventative and Adjunct Therapy for COVID-19

N-Acetylcysteine and Other Sulfur-Donors as a Preventative and Adjunct Therapy for COVID-19

Spontaneous large liver haematoma with extensive intraperitoneal bleeding in a patient with COVID-19 infection

Evaluation of the efficacy and safety of oral N‐acetylcysteine in patients with COVID‐19 receiving the routine antiviral and hydroxychloroquine protocol: A randomized controlled clinical trial

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