Findings of Hepatic Severe Acute Respiratory Syndrome Coronavirus-2 Infection.

Abstract

BACKGROUND & AIMS:

Liver injury due to coronavirus disease 2019 (COVID-19) is being increasingly recognized. Abnormal liver chemistry tests of varying severities occur in a majority of patients. However, there is a dearth of accompanying liver histologic studies in these patients.

METHODS:

The current report details the clinical courses of 2 patients having severe COVID-19 hepatitis. Liver biopsies were analyzed under light microscopy, portions of liver tissue were hybridized with a target probe to the severe acute respiratory syndrome coronavirus-2 S gene, and small sections from formalin-fixed paraffin-embedded liver tissue were processed for electron microscopy.

RESULTS:

The liver histology of both cases showed a mixed inflammatory infiltrate with prominent bile duct damage, endotheliitis, and many apoptotic bodies. In situ hybridization and electron microscopy suggest the intrahepatic presence of severe acute respiratory syndrome coronavirus-2, the findings of which may indicate the possibility of direct cell injury.

CONCLUSIONS:

On the basis of the abundant apoptosis and severe cholangiocyte injury, these histopathologic changes suggest a direct cytopathic injury. Furthermore, some of the histopathologic changes may resemble acute cellular rejection occurring after liver transplantation. These 2 cases demonstrate that severe COVID-19 hepatitis can occur even in the absence of significant involvement of other organs.

• Authors: M Isabel Fiel, Siraj M El Jamal, Alberto Paniz-Mondolfi, Ronald E Gordon, Jason Reidy, Jela Bandovic, Rashmi Advani, Saikiran Kilaru, Kamron Pourmand, Stephen Ward, Swan N Thung, Thomas Schiano
• Journal: Cellular and molecular gastroenterology and hepatology (Cell Mol Gastroenterol Hepatol) Vol. 11 Issue 3 Pg. 763-770 ( 2021) ISSN: 2352-345X [Electronic] United States
• PMID: 32992052 (Publication Type: Journal Article)
• Copyright: Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.

Topics

• Adult
• Apoptosis (physiology)
• Biopsy
• COVID-19 (virology)
• Female
• Hepatitis (pathology, virology)
• Humans
• Liver (pathology, virology)
• Liver Diseases (virology)
• Male
• Middle Aged
• SARS-CoV-2 (pathogenicity)