Post‐COVID‐19 syndrome mimicking cholangiocarcinoma: A case report

Abstract

Although the main impacts of COVID-19 (coronavirus disease 2019) are considered in the pulmonary system, recent studies highlight the liver as the mainly affected organ. Studies show that a significant percentage of COVID-19 patients suffer from hepatic injury, especially patients with critical or severe forms of COVID-19. Major reported pathological changes consist dilatation in the sinusoidal system, infiltration of lymphocytic cells in the sinusoidal system, multifocal hepatic necrosis, Kupffer cell hyperstimulation, and cholestasis. 1 Some fundamental mechanisms have been described for a hepatic malfunction that important causes include lowered blood oxygen saturation due to pneumonia, compromise of cardiac function, direct potential hepatotoxicity from therapeutic drugs (e.g., non-steroidal anti-inflammatory drugs (NSAIDs), hydroxychloroquine, and azithromycin), and cellular injury due to direct viral invasion, and micro and macrovascular changes from hypercoagulability. 2 Aberration in liver function test (LFT) occurs in 14%-53% of COVID-19 patients. 3 Most of these abnormalities in the LFT return to normal condition without specific treatment. Nevertheless, hepatic injuries occur when the LFT is thrice or higher than the normal limit, which may need attentive management. 2 A recent meta-analysis showed that liver vascular thrombosis and portal inflammation occurred in 29.4% and 13.2% of patients with a severe form of This study also showed that progressive ischemic injury in the liver biliary system might rapidly develop in some patients with severe illness, similar to the symptoms seen in the primary sclerosing cholangitis. This

COVID-19 and Its Sequelae Masquerading as Gastrointestinal Ailments: A Report of Gastroesophageal Reflux Disease (GERD) and Review of Recent Cases

“…The patient's SARS-CoV-2 test was also found to be positive and the authors suggested the possibility of AIH flare in this setting. Two other cases have been described in the setting of COVID-19 presenting with symptoms and workup resembling cholangiocarcinoma attributed to viralinduced cholangiopathy and portal vessel damage [24,26]. Finally, recent articles evaluating long COVIDassociated GI symptoms/conditions have proposed alternate mechanisms for their occurrence, such as residual replicative virus particles in GI and hepatic tissues, changes in the gut microbiome, and autoimmune processes, resulting in autonomic dysfunction including POTS-like presentations and/or GERD [19,20,27].…”