Case Report
Copyright ©The Author(s) 2022.
World J Hepatol. Aug 27, 2022; 14(8): 1678-1686
Published online Aug 27, 2022. doi: 10.4254/wjh.v14.i8.1678
Table 1 Clinical, images and histological characteristics of the patients reported with post-coronavirus disease 2019 cholangiopathy
Ref.
Patients
Underlying conditions
Drugs
ERCP
MR cholangiography
Liver biopsy
Follow-up
Knooihuizen et al[5]Female, 54 yrDiabetes, hypothyroidism, hypertension, and hyperlipidemiaHydromorphone, midazolam, propofol and ketamineNo reportedIntrahepatic dilatationwith a beaded appearance and dilated common bile duct with distal narrowingBiliary ductular reaction with lobular inflammation and one small non-necrotizing lobular granuloma without viral inclusionsContinued improvement
Edwards et al[6]Male, 59 yrNoneVancomycin and co-trimoxazoleSclerosing cholangitis in the intrahepatic ductsHypointense filling defects within the common bile duct and intrahepatic bile ducts were also dilated and demonstrated some beadingNot reportedNot reported
Mallet et al[7]3 males and 2 femalesHypertension, diabetes, one with KT and one with HBV infectionKetamine and no other drugs reportedFilling defects in CBD and rarefication of the intrahepatic biliary tractSclerosing cholangitis, with strictures and dilatations of intrahepatic bile ducts, peribiliary cysts and multiple biliary castsBiliary obstructions, cholangiolar proliferation, biliary plugs, portal inflammation with neutrophil infiltrates, extensive biliary fibrosis and cirrhosis1 died SSC and cirrhosis, 1 died biliary sepsis, 1 pruritus without jaundice and 2 recurrent biliary sepsis
Sanders et al[8]Male, 57 yrHypertension and diabetesNo reportedBile duct stone cast and intrahepatic duct stenosis without dilationNo reportedNo reportedNo reported
Durazo et al[9]Male, 47 yrObesity, OSA, hypertension, and hyperlipidemiaHCQSmall pigment stone and diffuse intrahepatic biliary stricturesMild intrahepatic biliary ductal dilatation with multifocal strictures or beading without extrahepatic biliary dilatationMononuclear inflammatory infiltration within the wall of the bile duct, bile lake associated with bile duct injury, microarteriopathy with endothelial cell swelling and obliteration of the lumen and obliterative portal venopathyOn day 108, the patient underwent an OLT
Roth et al[2]2 males and 1 femaleNone Multiple antibiotics2 sludge and stone extractedBeading, with multiple short segmental stricturesDuctal reaction, bile duct paucity, cholangiocyte swelling, cholangiocyte regenerative change, portal tract inflammation, endothelial swelling, focal endophlebitis portal veins, cholestasis hepatocanalicular and fibrosis No reported
Bütikofer et al[10]3 males and 1 femaleDiabetesKetamineNo reportedDiffuse irregularities of the bile ducts with dilatations and stricturesPortal edema, mixed portal inflammation and pronounced bile duct damage with ductular reaction as well as lobular bile infarcts and severe hepatocellular, canalicular, focally ductular cholestasis and pericellular fibrosis around portal tracts and central veins 1 cirrhosis Child B, MELD 17, 2 died pulmonary infection and 1 persistently increased ALP
Table 2 Clinical characteristics

Patient 1
Patient 2
Patient 3
Demographics
Age (yr)455246
SexMaleMaleFemale
ComorbiditiesT2D, HT, CKD KDIGO IIIT2D, HT, CKD KDIGO VT2D, HT, CKD KDIGO V
COVID-19 infection
ICU admissionYesYesYes
Mechanical ventilationYesYesYes
Vasopressor supportYesYesYes
Renal replacement therapyYesYes (on hemodialysis before admission)Yes (on hemodialysis before admission)
Secondary infectionsVentilator-associated pneumonia due to Enterobacter cloacae, Stenotrophomonas maltophilia and Klebsiella pneumoniaeStreptococcus pneumoniae and Staphylococcus aureus bacteremia. Ventilator-associated pneumonia due to Stenotrophomonas maltophilia, Enterobacter cloacae and Aspergillus fumigatusVentilator associated pneumonia due to Pseudomonas aeruginosa
AntibioticsMeropenem, vancomycin, ceftriaxone and co-trimoxazoleMeropenem, vancomycin, moxifloxacin, co-trimoxazole and voriconazoleImipenem, piperacillin/tazobactam and moxifloxacin
COVID-19 specific therapyDexamethasoneDexamethasoneDexamethasone
Liver chemistries on admission
TB (mg/dL)0.360.370.47
ALT (U/L)372011.8
AST (U/L)334635.9
ALP (U/L)8912891
Peak liver chemistries
TB (mg/dL)11.7222.717.32
ALT (U/L)6362.77.9
AST (U/L)119184.146.4
ALP (U/L)21462370705
Last liver chemistries
TB (mg/dL)6.418.82
ALT (U/L)489.3
AST (U/L)12952.6
ALP (U/L)32501870
Sclerosing cholangitis imaging findings (CT, ERCP, MRI) YesYesYes
HistologyIntracanalicular cholestasis, portal inflammation, ductular reaction and moderate portal fibrosisNoneNone
Evidence of liver fibrosisYes (histology)Yes (VCTE)No
DeathNoNoYes