Copyright ©The Author(s) 2023.
World J Gastroenterol. Apr 14, 2023; 29(14): 2127-2133
Published online Apr 14, 2023. doi: 10.3748/wjg.v29.i14.2127
Table 1 Liver biopsy and Imaging findings in few previously reported cases of coronavirus disease 2019 cholangiopathy
Pathology findings
Faruqui et al[5], 2021Acute and chronic large duct obstructionBeaded appearance of intrahepatic ducts
Peri-portal fibrosisBiliary hyper-enhancement
Roth et al[6], 2021Intra-hepatic ductal beadingBeaded appearance of bile ducts along with segments of strictures and dilation
Biliary strictures and dilation
Peri-portal fibrosis
Cholangiocyte regeneration
Endothelial swelling of hepatic arteries
Rojas et al[7], 2021CholestasisNo biliary obstruction
Peri-portal inflammation
Daneshjoo et al[22], 2020Enlarged portal tractsProminence of intra and extrahepatic bile ducts
Bile duct epithelial changes
Cholestasis, hepatocyte dropout and biliary metaplasia
Focal biliary infarcts
Tafreshi et al[17], 2021Bridging fibrosisBeaded appearance of intrahepatic bile ducts. Periductal prominence
Cholestasis and cholangiocyte injuryNormal liver parenchyma
Bile duct proliferation
Lee et al[16], 2021Bridging fibrosisMild intrahepatic ductal dilation
Onion skinning of bile ducts and cytoplasmic vacuolization of epithelium
Bile duct loss
Lymphoplasmacytic infiltration
Durazo et al[8], 2021Degenerative cholangiocyte injury and cytoplasmic vacuolizationBeaded appearance of intrahepatic ducts with multiple segmental strictures
Intrahepatic microangiopathy
Hepatic artery endothelial swelling, portal vein phlebitis, sinusoidal obstruction
Cesar Machado et al[23], 2022Cholangiocyte injuryMulti focal strictures and segmental dilation of intra and extra hepatic bile ducts
Neutrophilic infiltrate
Severe cholestasis and fibrosis
Table 2 Proposed mechanisms of coronavirus disease 2019 cholangiopathy
Proposed pathogenesis of COVID-19 cholangiopathy
1Cholangiocyte necrosis because of bile duct ischemia[24,25]
2Micro thrombosis of hepatic sinusoids and ischemic injury[6]
3Inflammation triggered due to cytokine release (cytokine release syndrome)
4Direct virus mediated damage[11]
5Drug induced liver injury in setting of severe COVID-19 infection (antibiotics, Remdesivir among others)
6Ketamine related cholangiopathy in setting of COVID-19[14]