Post-Covid-19 Cholangiopathy-A New Indication for Liver Transplantation: A Case Report

Abstract

Liver injury is one of the nonpulmonary manifestations described in coronavirus disease 2019 (COVID-19). Post-COVID-19 cholangiopathy is a special entity of liver injury that has been suggested as a variant of secondary sclerosing cholangitis in critically ill patients (SSC-CIP). In the general population, the outcome of SSC-CIP has been reported to be poor without orthotopic liver transplantation (OLT). However, the role of OLT for post-COVID-19 cholangiopathy is unknown. We present a case report of a 47-year-old man who recovered from acute respiratory distress syndrome from COVID-19 and subsequently developed end-stage liver disease from post-COVID-19 cholangiopathy. The patient underwent OLT and is doing well with normal liver tests for 7 months. To our knowledge, this is the first case report of a patient who underwent successful liver transplantation for post-COVID-19 cholangiopathy.

Fig 1

Endoscopic retrograde cholangiography showing a normal common bile duct with diffuse stricturing of the intrahepatic ducts.

Fig 2

Hilar bile duct with findings of inflammation and fibrosis (20×, hematoxylin and eosin stain). Red and black inserts (100×) show increased collagen deposition with associated mononuclear inflammatory infiltration within the wall of the bile duct.

Fig 3

Liver abscess occupying the bottom left field (40×, hematoxylin and eosin stain). One bile lake occupying top right field (insert, 400× hematoxylin and eosin stain, showing neutrophil-rich abscess contents).

Fig 4

Bile lake associated with bile duct injury with vacuolization and neutrophilia (400×, hematoxylin and eosin stain).

Fig 5

Microarteriopathy with endothelial cell swelling and obliteration of the lumen (400×, hematoxylin and eosin stain).

Fig 6

Obliterative portal venopathy (100×, hematoxylin and eosin stain).