Acute icteric hepatitis as the first isolated symptom of COVID-19

Abstract

Patients with COVID-19 may be asymptomatic or present with extrarespiratory symptoms, such as liver injury. It has been reported that 22.5%–46.2% of patients have moderate elevation of liver enzymes. To our knowledge, acute hepatitis has never been described as an isolated symptom of COVID-19 in a previously healthy patient. We report the case of a 53-year-old patient with COVID-19 whose first clinical presentation was acute icteric hepatitis, several days before the development of others symptoms. During the pandemic, we suggest that patients with acute hepatitis be considered as COVID-19 suspects, tested and isolated.

COVID-19-Triggered Acute Liver Failure and Rhabdomyolysis: A Case Report and Review of the Literature

“…Several reports have highlighted the occurrence of liver enzyme abnormalities, acute hepatitis, and an ALF associated with SARS-CoV-2 infection [ 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 ]. It has been documented that approximately 76.3% to 82.5% of COVID-19 cases display abnormal liver test results [ 35 , 37 ].…”

“…Several reports have highlighted the occurrence of liver enzyme abnormalities, acute hepatitis, and an ALF associated with SARS-CoV-2 infection [ 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 ]. It has been documented that approximately 76.3% to 82.5% of COVID-19 cases display abnormal liver test results [ 35 , 37 ]. Medetalibeyoglu et al further demonstrated that elevated levels of AST and ALT, along with an AST/ALT ratio greater than 1, indicated a more severe disease course and increased mortality in COVID-19 patients [ 26 ].…”

“…Among the reports, including a systematic review that provided laboratory data for reference, none documented cases that were complicated by both ALF and rhabdomyolysis in association with COVID-19 [ 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 51 ]. However, the information presented in these reports shows resemblances in the underlying factors between ALF and rhabdomyolysis.…”