Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Dec 27, 2022; 14(12): 1411-1417
Published online Dec 27, 2022. doi: 10.4240/wjgs.v14.i12.1411
Secondary sclerosing cholangitis in a young COVID-19 patient resulting in death: A case report
Jakob Steiner, Ann-Katrin Kaufmann-Bühler, Michael Fuchsjäger, Peter Schemmer, Emina Talakić
Jakob Steiner, Ann-Katrin Kaufmann-Bühler, Michael Fuchsjäger, Emina Talakić, Department of General Radiology, Medical University of Graz, Graz 8036, Austria
Peter Schemmer, Department of General Visceral and Transplant Surgery, Medical University of Graz, Graz 8036, Austria
Author contributions: Talakić E and Steiner J were responsible for the conceptualization, data acquisition and original manuscript drafting; Kaufmann-Bühler AK and Fuchsjäger M reviewed and edited the manuscript, and provided helpful discussions; Schemmer P was responsible for data acquisition and both reviewed and edited the manuscript; all authors have read and approved the final version of the manuscript.
Informed consent statement: No informed consent was required as the study was approved by the local IRB.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Emina Talakić, MD, Staff Physician, Department of General Radiology, Medical University of Graz, Auenbruggerplatz 9, Graz 8036, Austria. emina.talakic@medunigraz.at
Received: June 13, 2022
Peer-review started: June 13, 2022
First decision: July 14, 2022
Revised: July 28, 2022
Accepted: October 4, 2022
Article in press: October 4, 2022
Published online: December 27, 2022
Abstract
BACKGROUND

With the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in late 2019 in Wuhan, China, liver injury in patients with coronavirus disease 2019 (COVID-19) due to SARS-CoV-2 infection has been regularly reported in the literature. There are a growing number of publications describing the occurrence of secondary sclerosing cholangitis (SSC) after SARS-CoV-2 infection in various cases. We present a case of sudden onset SSC in a critically ill patient (SSC-CIP) following COVID-19 infection who was previously healthy.

CASE SUMMARY

A 33-year old female patient was admitted to our University Hospital due to increasing shortness of breath. A prior rapid antigen test showed a positive result for SARS-CoV-2. The patient had no known preexisting conditions. With rapidly increasing severe hypoxemia she required endotracheal intubation and developed the need for veno-venous extracorporeal membrane oxygenation in a setting of acute respiratory distress syndrome. During the patient´s 154-d stay in the intensive care unit and other hospital wards she underwent hemodialysis and extended polypharmaceutical treatment. With increasing liver enzymes and the development of signs of cholangiopathy on magnetic resonance cholangiopancreatography (MRCP) as well as endoscopic retrograde cholangiopancreatography (ERCP), the clinical setting was suggestive of SSC. At an interdisciplinary meeting, the possibility of orthotopic liver transplantation and additional kidney transplantation was discussed due to the constant need for hemodialysis. Following a deterioration in her general health and impaired respiratory function with a reduced chance of successful surgery and rehabilitation, the plan for transplantation was discarded. The patient passed away due to multiorgan failure.

CONCLUSION

SSC-CIP seems to be a rare but serious complication in patients with SARS-CoV-2 infection, of which treating physicians should be aware. Imaging with MRCP and/or ERCP seems to be indicated and a valid method for early diagnosis. Further studies on the effects of early and late SSC in (post-) COVID-19 patients needs to be performed.

Keywords: Secondary sclerosing cholangitis, COVID-19, Liver failure, Critically ill patients, Magnetic resonance cholangiopancreatography, Endoscopic retrograde cholangiopancreatography, Case report

Core Tip: Secondary sclerosing cholangitis in critically ill patients is an important complication in patients requiring intensive care treatment. With the ongoing coronavirus disease 2019 pandemic we will see increasing complications regarding the liver and the biliary system. Our case report hopes to aid other surgeons, radiologists and intensive care physicians in their decision making.