No abstract

No abstract

We present a case of acute-on-chronic liver failure (ACLF) in a patient with hepatitis B virus (HBV)-related decompensated cirrhosis and coronavirus disease 2019 (COVID-19). A 58-year-old woman with HBV-related and decompensated cirrhosis without any anti-viral treatment previously was admitted to the hospital due to a confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. On admission, she was in stable condition. Thoracic computed tomography (CT) and laboratory findings showed no significant abnormalities. Entecavir was initiated promptly for HBV, while antiviral therapy and supportive treatment were initiated for COVID-19. Her lung infection exacerbated after 10 days of recurrent fever despite treatments, and there were signs of HBV reactivation. ACLF and multiple organ dysfunction syndrome developed rapidly from day 10 to day 19. The patient's clinical deterioration was also consistent with pneumonia progression and elevated interleukin 6 levels. SARS-CoV-2 likely precipitated ACLF in cirrhotic patients, either by inducing HBV flare or serving as an acute insult directly. This study discussed the underlying mechanisms of this process and management details. Monitoring HBV status is necessary, and inflammatory parameters might be valuable. HBV suppression should be initiated early, and variceal hemorrhage primary prevention might be beneficial in COVID-19 patients with cirrhosis.

No abstract