Can COVID-19 Cause Flare-Ups of Acute Hepatitis B? An Atypical Presentation of COVID-19 with Acute Hepatitis B

Abstract

We report a case of fulminant liver failure in a patient with acute active hepatitis B infection who was found to have COVID-19 without lung involvement. A 24-year-old male was brought by ambulance service to Hamad General Hospital, Emergency Department (ED), in Doha on April 8, 2020, with chief complaints of fever and cough for 3 days. Upon initial evaluation, the patient was febrile (39.4°C), jaundiced, and disoriented regarding time, place, and person, with an unremarkable past medical history. Initial blood tests showed severely elevated urea, creatinine, transaminases, and ammonium in addition to an impaired coagulation profile consistent with fulminant liver failure. A swab was taken for COVID-19 PCR testing and found to be positive. Serological tests revealed hepatitis B surface antigen positivity and other serology indicating acute hepatitis B. Initial X-ray and repeat chest X-rays did not show lung infiltrates. On the 6th day after admission, the patient developed fixed dilated pupils, with brain edema on CT; cardiac arrest occurred on the 10th day after admission, and the patient died. Although it is still largely unclear, HBV0-activated sudden-onset strong cytotoxic T lymphocyte response and enhanced viral replication and/or retention of the viral capsid in infected hepatocytes may cause the pathogenesis of FH. These pathophysiological events cause extensive hepatocyte apoptosis and necrosis, which results in deadly severe liver failure. Our findings support that the liver damage occurring in COVID-19 is caused by an impaired innate immune system rather than by direct cell damage caused by SARS-CoV-2. We think that more consideration should be given to the presence of acute hepatitis B, especially in COVID-19 patients.

COVID-19 with acute hepatitis A virus co-infection in a fully-vaccinated individual: a case report

“…There were several reports of COVID-19 infection presenting as non-icteric hepatitis and COVID-19 infections inducing flares of pre-existing hepatitis B and hepatitis C infection, but co-infection with HAV as an acute viral illness in COVID-19 remain unreported to date (Akarele et al, 2021;Yigit et al, 2021;Aldhaleei et al, 2020). Coinfection of COVID-19 with multiple pathogens primarily infecting the respiratory tracts has also been reported, including various bacteria, viruses, and fungi (Lai et al, 2020).…”

Septic pulmonary embolism arising from a small temporal boil in a patient with diabetes mellitus type 2: A rare case report

“…These manifestations can overlap with those of respiratory or other conditions, further complicating the diagnostic process. 2,3 Early identification of such patients could lead to better results, fewer incorrect nonadmissions, and possibly shorter ICU stays. 4 We present a remarkable case of SPE originating from a small boil on the right temporal region, an atypical source of infection.…”

Emerging cases of acute hepatitis of unknown origin in children amid the ongoing COVID-19 pandemic: Needs attention – Correspondence

“…A 24-year-old COVID-19 male patient with acute active hepatitis B virus infection was reported by Yigit and coworkers [ 18 ]. The patient had fever and cough for three days.…”

“…The initial blood tests showed severely elevated urea, transaminases, creatinine, and ammonium in addition to severe liver failure. On the 10th day after admission, the patient developed cardiac arrest [ 18 ]. COVID-19 induced hepatitis is a novel clinical syndrome in this current pandemic.…”