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Case Reports
. 2021 May 24;9(5):e04068.
doi: 10.1002/ccr3.4068. eCollection 2021 May.

Secondary sclerosing cholangitis as a complication of severe COVID-19: A case report and review of the literature

Caroline Klindt  1 , Björn-Erik Jensen  1 , Timo Brandenburger  2 , Torsten Feldt  1 , Alexander Killer  1 , Lars Schimmöller  3 , Gerald Antoch  3 , Tina Senff  4 , Sandra Hauka  4 , Jörg Timm  4 , Bahne Hendrik Bahners  1 , Maximilian Seidl  5 , Irene Esposito  5 , Tom Luedde  1 , Johannes G Bode  1 , Verena Keitel  1
Affiliations
Case Reports

Secondary sclerosing cholangitis as a complication of severe COVID-19: A case report and review of the literature

Caroline Klindt et al. Clin Case Rep. .

Abstract

This case of secondary sclerosing cholangitis (SSC-CIP) emphasizes the need to provide follow-up care for patients that have recovered from COVID-19 in order to understand the complexity of SARS-CoV-2 associated sequela.

Keywords: COVID‐19; SARS‐CoV‐2; biliary epithelium; cholangiopathy; liver injury; secondary sclerosing cholangitis.

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Conflict of interest statement

The authors do not have any conflicts of interest to declare regarding this work. Verena Keitel received speaker's reimbursement from Falk Foundation, Albireo and Abbvie. Torsten Feldt reports role as country principal investigator for Germany for the SIMPLE studies for remdesivir and membership in the national advisory board for remdesivir, both without personal fees. Caroline Klindt reports personal fees and book gifts from Elsevier Publishing. Björn‐Erik Jensen reports personal fees from Gilead, personal fees from ViiV, personal fees from Janssen‐Cilag, personal fees from Theratechnologies, all outside the submitted work. Tina Senff, Timo Brandenburger, Sandra Hauka, Maximilian Seidl, Lars Schimmöller, Jörg Timm, Johannes G. Bode, Tom Luedde, Gerald Antoch, Bahne H. Bahners, Irene Esposito and Alexander Killer have nothing to disclose.

Figures

FIGURE 1
FIGURE 1
A. Serum levels of GGT (blue) and CRP (orange) at initial admission and at several time points up to 90 days follow‐up after initial presentation. Serum blood levels are depicted as amount relative to upper limit of normal of the respective laboratory. Time in hospital is indicated by a gray arrow. Time of remdesivir (rem) application is indicated by a green arrow. B. Serum levels of bilirubin (blue), alkaline phosphatase (ALP) (yellow), ALT (gray) and AST (orange) at initial admission and at several time points until 90 d follow‐up after initial presentation in hospital. Serum blood levels are depicted as time the upper normal limit of normal (x‐times ULN)
FIGURE 2
FIGURE 2
MRCP of the patient at follow‐up at day 79 after initial presentation (anterior‐posterior) showing multiple changes in the diameter of small‐ and medium‐sized intrahepatic bile ducts and an accentuation of the biliary ducts as it can be seen in sclerosing cholangitis
FIGURE 3
FIGURE 3
A. Overview of the liver biopsy showing intact architecture of the liver tissue (HE, 2×). B. Detail of an enlarged portal tract with mixed inflammatory infiltrate and degenerative changes of the bile duct epithelium (star) (HE, 10×). C. Periportal bile infarct (arrows) (HE, 10×). D. Bile infarct (arrow) of the zone 3 (*=central vein) (HE, 10×). E. Immunohistochemistry for CK7 highlights the distorted bile ducts (4×). F. Immunohistochemistry for Ki67 shows the high rate of proliferation of the bile duct epithelia (arrow) and the hepatocytes (4×)
See this image and copyright information in PMC

References

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