Khawaja Junaid, Bawa Aditi, Omer Hanan, Ashraf Farooq, Zulfiqar Palwasha
Internal Medicine, University of Pittsburgh Medical Center (UPMC) McKeesport, Pittsburgh, USA.
Internal Medicine, Gujranwala Medical College, Gujranwala, PAK.
Cureus. 2022 May 10;14(5):e24873. doi: 10.7759/cureus.24873. eCollection 2022 May.
The clinical features of severe acute respiratory syndrome-coronavirus disease 2019 (SARS-COVID-19) infection range from mild upper respiratory symptoms to severe acute respiratory failure. Among other less common features are diarrhea, nausea, vomiting, elevated liver enzymes, and acute kidney injury. We present a case of a 49-year-old female with no preexisting liver disease who presented with weakness and dizziness for one week. Initial investigations revealed acute liver failure (ALF) and positive COVID-19 on polymerase chain reaction (PCR) testing. The patient did not have any upper or lower respiratory symptoms, and extensive workup to look for other etiologies of acute liver failure was unremarkable. She eventually deteriorated to decompensated liver failure and was transitioned to comfort measures only. Liver injury is a well-documented phenomenon associated with COVID-19 infection. Some of the common pathophysiological mechanisms include direct liver injury, immune-mediated liver damage due to the severe inflammatory response, ischemic injury, endothelial disruption, and coagulopathy. Our case uniquely highlights that SARS-COVID-19 infection may have the potential to solely affect hepatocytes without the classic severe acute respiratory distress syndrome. This case demonstrates that a diagnosis of COVID-19 may be considered if no other etiology of ALF is identified.
严重急性呼吸综合征冠状病毒2019型（SARS-CoV-19）感染的临床特征范围从轻微的上呼吸道症状到严重的急性呼吸衰竭。其他不太常见的特征包括腹泻、恶心、呕吐、肝酶升高和急性肾损伤。我们报告一例49岁女性病例，该患者既往无肝病，出现乏力和头晕一周。初步检查显示急性肝衰竭（ALF），聚合酶链反应（PCR）检测新冠病毒呈阳性。该患者没有任何上呼吸道或下呼吸道症状，广泛检查以寻找急性肝衰竭的其他病因，结果均无异常。她最终病情恶化至失代偿性肝衰竭，仅接受了姑息治疗。肝损伤是与新冠病毒感染相关的一种有充分文献记载的现象。一些常见的病理生理机制包括直接肝损伤、严重炎症反应导致的免疫介导肝损伤、缺血性损伤、内皮破坏和凝血病。我们的病例独特地突出了SARS-CoV-19感染可能有仅影响肝细胞而无典型严重急性呼吸窘迫综合征的可能性。该病例表明，如果未发现急性肝衰竭的其他病因，则可考虑诊断为新冠病毒感染。
