Case Report
Copyright ©The Author(s) 2021.
World J Clin Cases. Jun 6, 2021; 9(16): 4032-4039
Published online Jun 6, 2021. doi: 10.12998/wjcc.v9.i16.4032
Table 1 Laboratory assessment at hospital admission and throughout follow-up
Parameter
Day 3
Day 7
Day 11
Day 17
Day 20
Day 24
Day 25
Day 26
Day 27
Day 32
Day 43
Day 69
Day 104
Day 145
Day 193
Day 257
Hematology
White blood cells (3.6-9.6) × 103/µL4.53.95.87.66.66.75.75.74.3
Neutrophils (1.4-6.5) × 103/µL1.81.73.03.83.43.53.13.32.0
Lymphocytes (1.2-3.4) × 103/µL1.81.72.02.72.22.21.71.61.7
Hemoglobin (12.1-17.2) g/dL15.615.215.515.815.815.215.015.614.3
Platelets (200-400) × 103/µL205188266311265254245255215
Coagulation
D-dimers hs (50-230) ng/mL6838101856302361
Activated partial thromboplastin time (24-38) s31.633.435.431.932.327.2
Prothrombin concentration (80-115) %759573.9898490898386837572.686.9
Biochemistry
ALT (4-50) U/L286421130934973662759252327046231913
AST (17-59) U/L28505913942901961481136328242218
Total bilirubin (0.2-1.3) mg/dL0.40.40.40.60.50.60.50.50.80.60.60.60.6
Direct bilirubin (0.0–0.4) mg/dL0.10.10.10.10.10.10.10.10.20.20.20.20.2
GGT (15-85) U/L29386481949392867446262214
Alkaline phosphatase (38-126) U/L58697165676569
Albumin (3.5-5) g/dL4.74.54.94.64.8
Amylase (30-110) U/L5957
Lipase (23-300) U/L3537
Creatine kinase (55-170) U/L89594652566259585478117
Creatine kinase-MB (1-16) U/L966747610759
Fasting plasma glucose (74-106) mg/dL841029786889890928489879697
Lactate dehydrogenase (120-246) U/L189221214252258426378285245260189172162145
Total proteins (6.3-8.2) g/dL7.98.08.28.27.98.78.28.57.87.97.8
Cholesterol (50-200) mg/dL150196151
HDL-cholesterol (40-60) mg/dL4648
Total lipids (400-800) mg/dL705482
Triglycerides (15-150) mg/dL6217452
Creatinine (0.7-1.3) mg/dL0.90.80.80.70.80.80.60.60.90.70.70.70.70.6
Urea (15-45) mg/dL31272727.5202828293434413335
Sodium (137-145) mmol/L143141142142141139140141141142141143
Potassium (3.6-5.0) mmol/L4.34.44.64.44.44.74.74.84.64.54.34.7
Calcium (8.4-10.2) mg/dL9.39.49.99.79.710.09.99.99.9
Inflammatory markers
C-reactive protein (0-3) mg/L6.201.620.991.751.370.78
Erythrocyte sedimentation rate mm/h10168
Fibrinogen (200-393) mg/dL250243196227221254246244269260221
Ferritin (22-322) ng/mL149.7173.8166.3
IL-6 (0-9.7) pg/mL0.4530.420
TNF-α (0-1.9) pg/mL0.00.0
Procalcitonin (0-0.5) ng/mL0.050.05
Cardiac markers
Myoglobin (0-99.3) ng/mL47.436.7
NT-proBNP (0-125) ng/L55
Troponin I (0-0.16) ng/mL0.030.03
SARS-CoV-2 antibodies
Total SARS-CoV-2 Ab (0.00-0.99) S/CO29.26211013216617318018822530549872186565485.1
Table 2 Differential diagnosis of hepatic cytolysis
Hypothesis
Investigation and result
Drug-induced liver injuryNo drugs recently administered
Systemic replication of SARS-CoV-2Negative SARS-CoV-2 RT-PCR from blood and nasopharyngeal + oropharyngeal swabs
COVID-19 cytokine storm Timing–day 24
Normal inflammatory markers
Normal chest CT at baseline and on day 24
Infections with other hepatotropic virusesNegative: HAV IgM, HBsAg, HCV Abs, HEV IgM and HEV-RNA, adenovirus IgM, coxsackie virus IgM, echo virus IgM, HSV1+2 IgM, EBV IgM, CMV IgM.
Post-COVID-19 immune hepatitisRapidly increasing SARS-CoV-2 antibodies (chemiluminescence)