May 2022 acute hepatitis outbreak, is there a role for COVID-19 and other viruses?

Figure 4 Effect of coronavirus disease 2019 infection on the liver as indicated by increased liver enzymes. The virus reaches the liver from the gut-liver-lung axis and may be re-shed back to the gut through the bile. These effects are mediated through the impact of hypoxia, systemic venous congestion, immune-mediated hepatic damage by inflammatory mediators induced by severe acute respiratory syndrome coronavirus-2 infection (SARS-CoV-2), the direct hepatic cytopathic effect of SARS-CoV-2, and the hepatotoxic effects of some medications used to treat SARS-CoV-2 infection such as azithromycin, chloroquine, lopinavir, ritonavir, and tocilizumab. GIT: Gastrointestinal tract; IL-6: Interleukin 6.