Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 6, 2021; 9(16): 4032-4039
Published online Jun 6, 2021. doi: 10.12998/wjcc.v9.i16.4032
Transient immune hepatitis as post-coronavirus disease complication: A case report
Anca Cristina Drăgănescu, Oana Săndulescu, Anuța Bilașco, Camelia Kouris, Anca Streinu-Cercel, Monica Luminos, Adrian Streinu-Cercel
Anca Cristina Drăgănescu, Oana Săndulescu, Anuța Bilașco, Camelia Kouris, Anca Streinu-Cercel, Monica Luminos, Adrian Streinu-Cercel, Infectious Diseases Department, National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, Bucharest 021105, Romania
Oana Săndulescu, Anca Streinu-Cercel, Monica Luminos, Adrian Streinu-Cercel, Infectious Diseases Department,Carol Davila University of Medicine and Pharmacy, Bucharest 021105, Romania
Author contributions: Drăgănescu AC, Săndulescu O, Bilașco A, Kouris C, Streinu-Cercel An, Luminos M, and Streinu-Cercel Ad had equal contributions to the article and were involved in patient management, acquisition, analysis, or interpretation of data for the work; drafted the work or revised it critically for important intellectual content; gave final approval of the version to be published, and agree to be accountable for all aspects of the work.
Informed consent statement: Written informed consent was obtained from the patient for the publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Oana Săndulescu, MD, PhD, Associate Professor, Infectious Diseases Department, National Institute for Infectious Diseases “Prof. Dr. Matei Bals”, Carol Davila University of Medicine and Pharmacy, No. 1 Dr. Calistrat Grozovici Street, Bucharest 021105, Romania. oana.sandulescu@umfcd.ro
Received: January 12, 2021
Peer-review started: January 12, 2021
First decision: February 11, 2021
Revised: February 25, 2021
Accepted: March 24, 2021
Article in press: March 24, 2021
Published online: June 6, 2021
Abstract
BACKGROUND

We report a case of post-coronavirus disease (COVID) immune hepatitis occurring in a young male with no pre-existing comorbidities.

CASE SUMMARY

A previously healthy 21-year-old male patient was admitted to our hospital with mild COVID-19. During the course of in-hospital isolation and monitoring, he developed an alanine aminotransferase (ALT) and aspartate aminotransferase (AST) increase, with the enzymes peaking at day 24 (ALT 15 times the upper normal limit), with preserved liver function. The liver enzyme increase occurred 20 d after the complete clinical remission of COVID-19, and ALT dynamics paralleled the increase in total antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The case was interpreted as post-COVID immune hepatitis, with extensive laboratory investigations excluding other potential causes. The hepatocytolysis remitted 20 d after the peak ALT, without further intervention, with complete recovery, but the total anti-SARS-CoV-2 antibodies continued to increase the next 5 mo following the acute infection.

CONCLUSION

Close attention should also be paid to young patients with mild forms of disease, and a high index of suspicion should be maintained for post-COVID complications.

Keywords: COVID-19, Complications, Liver, Case report

Core Tip: We report an interesting case of post-coronavirus disease immune hepatitis occurring in a young male with no pre-existing comorbidities. The patient acquired the infection from an asymptomatic carrier of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). He developed a mild form of disease, but after apparent clinical remission and real-time reverse transcription polymerase chain reaction negative conversion, an important increase in liver enzymes was recorded in parallel with an increasing SARS-CoV-2 antibody titer.