Findings of Hepatic Severe Acute Respiratory Syndrome Coronavirus-2 Infection

Abstract

Background and Aims Liver injury due to COVID-19 is being increasingly recognized. Abnormal liver chemistry tests of varying severities occur in a majority of patients. However, there is a dearth of accompanying liver histologic studies in these patients. Methods: The current report details the clinical courses of two patients having severe COVID-19 hepatitis. Liver biopsies were analyzed under light microscopy, portions of liver tissue were hybridized with a target probe to the SARS-CoV-2 S gene, and small sections from formalin-fixed paraffin embedded liver tissue were processed for electron microscopy. Results The liver histology of both cases showed a mixed inflammatory infiltrate with prominent bile duct damage, endotheliitis and many apoptotic bodies. In-situ hybridization and electron microscopy suggest the intrahepatic presence of the severe acute respiratory syndrome corona virus-2 (SARS-CoV-2), the findings of which may indicate the possibility of direct cell injury. Conclusions Based on the abundant apoptosis and severe cholangiocyte injury, these histopathological changes suggest a direct cytopathic injury. Furthermore, some of the histopathological changes may resemble acute cellular rejection occurring after liver transplantation. These two cases demonstrate that severe COVID-19 hepatitis can occur even in the absence of significant involvement of other organs.

Liver injury in the era of COVID-19

“…Liver histology in other COVID-19 cases presented a mixed inflammatory infiltration with marked bile duct damage, features of endotheliitis and many apoptotic bodies. The intrahepatic presence of SARS-CoV-2 was even suggested in electron microscopy and in-situ hybridization, indicating the possibility of direct cell injury[ 93 ]. The ultrastructural assessment of postpartum liver tissue biopsies derived from two deceased COVID-19 patients by Wang et al [ 94 ] revealed typical coronavirus particles with their spikes in the cytoplasm of hepatocytes.…”

Case Report: SARS-CoV-2 as an unexpected causal agent of isolated febrile hepatitis

“…While concomitant liver injury has been commonly observed among patients with severe COVID-19 pneumonia 3,4 , clinical presentation of COVID-19 with hepatitis as the predominant feature has been rarely reported [5][6][7] . All these cases had positive PCR for SARS-CoV-2 in nasopharyngeal swabs at admission, three had concomitant pulmonary involvement and two had predisposing liver conditions (e.g.…”

“…Liver injury with mild or moderate elevation of transaminases has been observed in about half of patients requiring hospital admission for severe COVID-19 3,4 . However, acute febrile hepatitis as a predominant manifestation of COVID-19 has been rarely reported and has been mainly observed among patients with underlying liver diseases and/or concomitant signs of upper or lower respiratory tract involvement with diagnosis established by polymerase chain reaction (PCR) in nasopharyngeal swabs [5][6][7] . We report here a case of a young previously healthy man presenting with febrile hepatitis as a unique clinical manifestation, for which diagnosis of COVID-19 was established by seroconversion.…”

Liver injury in COVID-19: Detection, pathogenesis, and treatment

“…Death may occur long after the acute liver injury is noted; subsequently, histological changes may have been eliminated or obscured, and viral load would have diminished over time. Fiel et al [ 18 ] presented their findings from two liver biopsies performed on patients infected with SARS-CoV-2. Both patients had severe hepatic failure in the absence of obvious involvement of other organs.…”