COVID-19 Liver

Updated May 24, 2024

MAY 2020: SARS-CoV-2 Infection May Present as Acute Hepatitis in Children (Per Infectious Disease Journal)
“Our case suggests an unreported association between acute SARs-CoV-2 infection and acute hepatitis in children, thus supporting the notion that evaluation of liver enzymes during hospitalization for SARs-CoV-2 infection is also indicated in pediatric age.”

10 MAY 2020: SARS-CoV-2 infection of the liver directly contributes to hepatic impairment in patients with COVID-19 (Journal of Hepatology)
“SARS-CoV-2 infection in the liver directly contributes to hepatic impairment in patients with COVID-19. Hence, a surveillance of viral clearance in liver and long-term outcome of COVID-19 is required.”

JAN 2021: Acute hepatitis caused by asymptomatic COVID-19 infection (J Infect)
“We report here the case of a young woman diagnosed with COVID-19 infection in absence of respiratory symptoms, presenting at the admission with significant elevation of liver function tests compatible with acute hepatitis.”

21 JAN 2022: Case Report: Fatal Acute Liver Failure With Giant Cell Transformation in a Pediatric Patient Associated With MIS-C (Front. Ped.)
”We report a case of SARS-COV-2 infection probably presenting as rapidly progressive fulminant liver failure without respiratory symptoms”

8 DEC 2021: Residual SARS-CoV-2 viral antigens detected in GI and hepatic tissues from five recovered patients with COVID-19 (Gut BMJ)
“Using conventional immunohistochemistry, we detected SARS-CoV-2 nucleocapsid protein (NP) in the colon, appendix, ileum, haemorrhoid, liver, gallbladder and lymph nodes from five patients who recovered from COVID-19, ranging from 9 to 180 days after testing negative for SARS-CoV-2. Notably, when multiple tissues were obtained from one patient (patients 1 and 4), all the tissues showed the presence of the viral antigen, suggesting widespread multiorgan involvement of the viral infection.”

25 FEB 2022: Intracellular Reverse Transcription of Pfizer BioNTech COVID-19 mRNA Vaccine BNT162b2 In Vitro in Human Liver Cell Line (current issues in molecular biology)

May 2022: Pediatric Acute Liver Failure Due to Type 2 Autoimmune Hepatitis Associated With SARS-CoV-2 Infection: A Case Report (JPGM)
“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.” 

9 MAY 2022: COVID-19 Associated Hepatitis in Children (CAH-C) during the second wave of SARS-CoV-2 infections in Central India: Is it a complication or transient phenomenon (medRxiv preprint)
Among 475 children tested positive, 47 patients presented with hepatitis, 37 patients had features of CAH-C, having symptoms of hepatitis only, with un-elevated inflammatory markers and uneventful recovery following supportive treatment. Whereas remaining 10 MIS-C hepatitis had protracted illness, multiple system involvement, required admission to critical care, and had mortality of 30%.”

12 MAY 2022: High population burden of Omicron variant (B.1.1.529) is associated with the emergence of severe hepatitis of unknown etiology in children (Intl Journal of Infectious Diseases)
“Prior exposure to Omicron variant may be associated with an increased risk of severe hepatitis among children, indicating a critical need to conduct cofactor studies.”

13 MAY 2022: Severe acute hepatitis in children: investigate SARS-CoV-2 superantigens (Lancet)
“we suggest that children with acute hepatitis be investigated for SARS-CoV-2 persistence in stool, T-cell receptor skewing, and IFN-γ upregulation, because this could provide evidence of a SARS-CoV-2 superantigen mechanism in an adenovirus-41F-sensitised host. If evidence of superantigen-mediated immune activation is found, immunomodulatory therapies should be considered in children with severe acute hepatitis.”

14 MAY 2022: Elevated liver enzymes and bilirubin following SARS-CoV-2 infection in children under 10 (medRxiv preprint)
Compared to children infected with other respiratory infections, children infected with COVID-19 infection were at significantly increased risk for elevated AST or ALT (hazard ratio or HR: 2.52, 95% confidence interval or CI: 2.03-3.12) and total bilirubin (HR: 3.35, 95% CI: 2.16-5.18). These results suggest acute and long-term hepatic sequelae of COVID-19 in pediatric patients. Further investigation is needed to clarify if post-COVID-19 related hepatic injury described in this study is related to the current increase in pediatric hepatitis cases of unknown origin.”

17 MAY 2022: Acute hepatitis of unknown origin in children (BMJ Editorial)

23 MAY 2022: SARS-CoV-2 ORF1abA1061S potentiate autoreactive T cell responses via epitope mimicry: an explanation to hepatitis of unknown cause (bioRxiv preprint)
“our preliminary results raised a possibility that infection by SARS-CoV-2 ORF1abVVVNASN variant might elicit an autoimmune T cell response via epitope mimicry and is associated with the outbreak of unknown hepatitis”

10 JUN 2022: Outbreak of hepatitis in children: clinical course of children with acute liver failure admitted to the intensive care unit (Intensive Care Medicine)
“histopathology studies on the explant liver and in a few who have had biopsies have not demonstrated evidence of adenovirus in hepatocytes, though all of them revealed hepatocyte necrosis and parenchymal collapse. The lack of adenovirus demonstration in hepatocytes, but severe liver injury leading to acute liver failure may be related to an aberrant immune response from the host’s immune system of liver…”

10 JUN 2022: Long COVID-19 Liver Manifestation in Children (JPGN)
“We report two distinct patterns of potentially long COVID-19 liver manifestations in children with common clinical, radiological, and histopathological characteristics after a thorough workup excluded other known etiologies.”

NOV 2023: T cell cross-reactivity in autoimmune-like hepatitis triggered by COVID-19 (hLife)
“Thus, we hypothesized that following SARS-CoV-2 infection or vaccination, T cells carrying TCRs that recognize self-antigens undergo clonal expansion, which could eventually result in the onset of autoimmune-like hepatitis “