Transient immune hepatitis as post-coronavirus disease complication: A case report

Abstract

Background: We report a case of post-coronavirus disease (COVID) immune hepatitis occurring in a young male with no pre-existing comorbidities.

Case summary: A previously healthy 21-year-old male patient was admitted to our hospital with mild COVID-19. During the course of in-hospital isolation and monitoring, he developed an alanine aminotransferase (ALT) and aspartate aminotransferase (AST) increase, with the enzymes peaking at day 24 (ALT 15 times the upper normal limit), with preserved liver function. The liver enzyme increase occurred 20 d after the complete clinical remission of COVID-19, and ALT dynamics paralleled the increase in total antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The case was interpreted as post-COVID immune hepatitis, with extensive laboratory investigations excluding other potential causes. The hepatocytolysis remitted 20 d after the peak ALT, without further intervention, with complete recovery, but the total anti-SARS-CoV-2 antibodies continued to increase the next 5 mo following the acute infection.

Conclusion: Close attention should also be paid to young patients with mild forms of disease, and a high index of suspicion should be maintained for post-COVID complications.

Keywords: COVID-19; Case report; Complications; Liver.

Figure 1

Patient evolution chart throughout the duration of hospitalization. ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; SARS-CoV-2: Severe acute respiratory syndrome coronavirus 2; RT-PCR: Real-time reverse transcription polymerase chain reaction.

Figure 2

Dynamics of alanine aminotransferase, aspartate aminotransferase and severe acute respiratory syndrome coronavirus 2 antibodies. ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; SARS-CoV-2: Severe acute respiratory syndrome coronavirus 2.