Sweed Dina, El Shanshory Mohamed Ramadan, Elaskary Eman Mohammed, Hassan Hassnaa Atef, Sweed Enas, Sweed Eman, Abdelsattar Shimaa, Abdelgawad Ahmed, Mosbeh Asmaa, Abdallah Heba, El-Mashad Shereen, Ehsan Nermine
Pathology Department, National Liver Institute, Menoufia University, Shibin el Kom, Egypt.
Pediatric Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
Egypt Liver J. 2021;11(1):69. doi: 10.1186/s43066-021-00140-5. Epub 2021 Aug 23.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection mainly affects respiratory system. Later, liver affection has also been reported in the form of marked elevated liver enzymes. However, the association of coronavirus disease-19 (COVID-19) and autoimmune diseases is not clear.
A female patient with a known history of autoimmune hemolytic anemia (AIHH) for which she was treated with prednisolone was admitted for uncontrolled anemia followed by fever and elevated liver enzymes. All the laboratory and radiological investigations were not typical for COVID-19 or any other etiology. Liver biopsy revealed numerous pale eosinophilic trichrome-positive intracytoplasmic globules. The pathology raised the suspicion for SARS-CoV-2-associated hepatitis, which was confirmed by a positive IgG titer. The patient showed a dramatic improvement on the maintenance dose of prednisolone.
AIHA patients co-infected with SARS-CoV-2 may be at risk of uncontrolled disease and should continue their treatment regimen. Histopathology has a role in the diagnosis of liver affection due to SARS-CoV-2 infection.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染主要影响呼吸系统。后来，也有以肝酶显著升高形式出现的肝脏受累的报道。然而，冠状病毒病-19（COVID-19）与自身免疫性疾病之间的关联尚不清楚。
一名有自身免疫性溶血性贫血（AIHH）病史且曾接受泼尼松龙治疗的女性患者因贫血控制不佳、随后出现发热和肝酶升高而入院。所有实验室和影像学检查结果对于COVID-19或任何其他病因均不典型。肝活检显示大量淡嗜酸性三色染色阳性的胞质内小球。病理检查引发了对SARS-CoV-2相关性肝炎的怀疑，IgG滴度阳性证实了这一点。该患者在泼尼松龙维持剂量治疗下有显著改善。
合并SARS-CoV-2感染的AIHA患者可能有疾病控制不佳的风险，应继续其治疗方案。组织病理学在诊断SARS-CoV-2感染引起的肝脏受累方面具有作用。
