Osborn Julie, Szabo Sara, Peters Anna L
Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Division of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
JPGN Rep. 2022 Apr 27;3(2):e204. doi: 10.1097/PG9.0000000000000204. eCollection 2022 May.
Although elevated liver enzymes are common in hospitalized children with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, pediatric acute liver failure is an uncommon manifestation of COVID-19 disease. We describe the case of a 3-year-old previously healthy female who developed acute liver failure secondary to type 2 autoimmune hepatitis preceded by mild infection with SARS-CoV-2. Testing for viral hepatitis was negative, and the patient did not meet diagnostic criteria for multisystem inflammatory disease in children (MIS-C). A liver biopsy showed acute submassive hepatocyte necrosis with brisk CD3+ T lymphocyte infiltration and no evidence of fibrosis or chronic liver disease. Treatment with high-dose methylprednisolone resulted in rapid normalization of alanine aminotransferase (ALT), aspartate aminotransferase (AST), international normalized ratio (INR), and ammonia levels, and liver transplantation was avoided. This case highlights a possible association between SARS-CoV-2 infection and subsequent development of autoimmune liver disease presenting with acute liver failure.
尽管在感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的住院儿童中，肝酶升高很常见，但小儿急性肝衰竭是冠状病毒病2019（COVID-19）的一种不常见表现。我们描述了一名3岁既往健康的女性病例，该患儿在轻度感染SARS-CoV-2后，继发2型自身免疫性肝炎，进而发展为急性肝衰竭。病毒性肝炎检测为阴性，且该患者不符合儿童多系统炎症性疾病（MIS-C）的诊断标准。肝活检显示急性亚大块肝细胞坏死伴活跃的CD3+T淋巴细胞浸润，无纤维化或慢性肝病证据。高剂量甲泼尼龙治疗使丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、国际标准化比值（INR）和血氨水平迅速恢复正常，避免了肝移植。该病例凸显了SARS-CoV-2感染与随后出现急性肝衰竭的自身免疫性肝病之间可能存在的关联。
