Secondary sclerosing cholangitis after critical COVID-19: Three case reports

Mayorquín-Aguilar, Juan M; Lara-Reyes, Aldo; Revuelta-Rodríguez, Luis Alberto; Flores-García, Nayelli C; Ruiz-Margáin, Astrid; Jiménez-Ferreira, Marco Antonio; Macías-Rodríguez, Ricardo Ulises

doi:10.4254/wjh.v14.i8.1678

Cited by 7 publications

(14 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Hepatocellular and canalicular cholestasis, and in some cases zone 3 hepatocellular necrosis, can be seen. [85][86][87][88] SARS-CoV-2 protein showed mostly weak and patchy granular cytoplasmic immunostaining in hepatocytes and cholangiocytes as demonstrated in various studies. 22,62,74,84 Viral RNA has been identified in hepatocytes as well as in endothelial cells and vascular thrombi in half of the cases, and this was not significantly associated with transaminase elevations.…”

Section: Large Intestinementioning

confidence: 55%

“…Microvascular alteration is another important feature of this entity, characterized by hepatic artery endothelial swelling, portal vein endophlebitis, fibrotic obliteration of the terminal hepatic vein, and sinusoidal obstruction syndrome. Hepatocellular and canalicular cholestasis, and in some cases zone 3 hepatocellular necrosis, can be seen 85–88 …”

Section: Histopathological Findings In Digestive Tract Organsmentioning

confidence: 99%

“…Hepatocellular and canalicular cholestasis, and in some cases zone 3 hepatocellular necrosis, can be seen. 85 – 88 …”

Section: Histopathological Findings In Digestive Tract Organsmentioning

confidence: 99%

See 2 more Smart Citations

The Spectrum of Digestive Tract Histopathologic Findings in the Setting of Severe Acute Respiratory Syndrome Coronavirus-2 Infection: What Pathologists Need to Know

Al-Zaidi

2023

Advances in Anatomic Pathology

View full text Add to dashboard Cite

Although the novel severe acute respiratory syndrome coronavirus-2 is known primarily to affect the respiratory system, current evidence supports its capability to infect and induce gastrointestinal tract injury. Data describing the histopathologic alterations of the digestive system in patients infected with severe acute respiratory syndrome coronavirus-2 are becoming more detailed, as the number of studies is increasing and the quality of our insight into the infection and the histopathologic findings is improving. This review highlights the range of pathologic findings that could be observed in gastrointestinal specimens from patients infected with coronavirus disease 2019 and the potential underlying pathogenetic mechanisms of this disease.

show abstract

Section: Large Intestinementioning

confidence: 55%

Section: Histopathological Findings In Digestive Tract Organsmentioning

confidence: 99%

See 1 more Smart Citation

The Spectrum of Digestive Tract Histopathologic Findings in the Setting of Severe Acute Respiratory Syndrome Coronavirus-2 Infection: What Pathologists Need to Know

Al-Zaidi

2023

Advances in Anatomic Pathology

View full text Add to dashboard Cite

show abstract

“…Histologic findings from liver biopsies demonstrated ductal injury and retraction, consistent with post-COVID-19 cholangiopathy. While prior cases have not reported on patient’s cholesterol profile ( 6 , 7 ), at least one case reported a total cholesterol of 1920mg/dl, although this was not further addressed in the manuscript ( 9 ). Therefore, the cases reported here are unique in that they are the first to report the detection of LpX in patients with complicated courses of COVID-19.…”

Section: Discussionmentioning

confidence: 92%

Hypercholesterolemia After COVID-19: Time to Include Lipoprotein X Among the Differential Diagnoses

Girard¹,

Wagner²,

Ravi³

et al. 2023

AACE Clinical Case Reports

View full text Add to dashboard Cite

“…The authors found many similarities between their patients and those reported by Roth, concluding that COVID-19 SSC may represent a confluence between SSC-CIP and direct viral damage, even if a DILI, as aggravating factor, could not be discarded. 86 …”

Section: Post Covid-19 Secondary Sclerosing Cholangitis (Ssc)mentioning

confidence: 99%

Secondary Sclerosing Cholangitis After SARS-CoV2: ICU Ketamine Use or Virus-Specific Biliary Tropism and Injury in the Context of Biliary Ischemia in Critically Ill Patients?

Bartoli¹,

Cursaro²,

Seferi³

et al. 2023

HMER

View full text Add to dashboard Cite

Purpose From the beginning of the Severe Acute Respiratory Syndrome CoronaVirus-2 (SARS-CoV2) pandemic, different cases of a cholangiopathy with features of secondary sclerosing cholangitis in critically ill patients (SSC-CIP) have been reported. Patients developing it are generally recovering from severe Coronavirus disease 19 (COVID-19) and required intensive care unit (ICU) admission and mechanical ventilation. Many of them have been administered with ketamine during their ICU stay. The pathogenesis of this novel disease is still debated, and, since prognosis is poor, efforts are needed in order to better understand it. Patients and Methods In this review, we focused our attention on COVID-19 SSC clinical, imaging, and histology findings in order to clarify the different pathogenetic options, particularly in regard of the ischemic-direct viral damage and ketamine-related theories, beginning with a recapitulation of SSC-CIP and ketamine-induced cholangiopathy in abusers. The research has been conducted using PubMed and Google Scholar databases. Key-words were “Secondary Sclerosing Cholangiopathy”, “SSC-CIP”, “Secondary Sclerosing Cholangiopathy in critically ill patients”, “Ketamine and cholangiopathy”, “Ketamine abusers and liver disease”, “Ketamine-related cholangiopathy”, “SARS-CoV2 infection and liver disease”, “post Covid-19 secondary sclerosing cholangitis”, “Covid-19 cholangiopathy”. Results Many authors, based on the clinical, histological, imaging, and prognostic features of the disease, have pointed out the similarities between post COVID-19 SSC and SSC-CIP; however, peculiar features in the former were not previously observed. Therefore, a direct viral cytopathic action and SARS-CoV2-related coagulopathy are considered the most likely causes. On the other hand, ketamine, with the available data, cannot be surely linked as the main determinant cause of cholangiopathy. Moreover, ketamine-induced cholangitis (KIC) presentation is different from post COVID-19 SSC. Its role as a cofactor precipitating the disease cannot be ruled out. Conclusion Post COVID-19 SSC is a rare clinical entity following severe COVID-19 disease. The most accepted theory is that a sum of different insults determines the disease: biliary ischemia, direct viral damage, toxic bile, possibly worsened by ketamine and hyperinflammation due to the cytokine storm. Given the severe prognosis of the disease, with persistent cholangiopathy, organ failure, and orthotopic liver transplantation (OLT), further study on this novel clinical entity is needed.

show abstract

Secondary sclerosing cholangitis after critical COVID-19: Three case reports

Cited by 7 publications

References 10 publications

The Spectrum of Digestive Tract Histopathologic Findings in the Setting of Severe Acute Respiratory Syndrome Coronavirus-2 Infection: What Pathologists Need to Know

The Spectrum of Digestive Tract Histopathologic Findings in the Setting of Severe Acute Respiratory Syndrome Coronavirus-2 Infection: What Pathologists Need to Know

Hypercholesterolemia After COVID-19: Time to Include Lipoprotein X Among the Differential Diagnoses

Secondary Sclerosing Cholangitis After SARS-CoV2: ICU Ketamine Use or Virus-Specific Biliary Tropism and Injury in the Context of Biliary Ischemia in Critically Ill Patients?

Contact Info

Product

Resources

About