tetano
Editor, Senior Moderator
AACE Clin Case Rep
. 2023 Jan 7.
doi: 10.1016/j.aace.2023.01.001. Online ahead of print.
Hypercholesterolemia After Coronavirus Disease-19 (COVID-19): Time to Include Lipoprotein X among the Differential Diagnoses
Jennifer Girard[SUP] 1 [/SUP], Courtney Wagner[SUP] 1 [/SUP], Sujan Ravi[SUP] 2 [/SUP], Monica Agarwal[SUP] 3 4 [/SUP], Fernando Bril[SUP] 3 4 [/SUP]
Affiliations
Abstract
Background/objective: Lipoprotein X (LpX) is an abnormal lipoprotein composed of phospholipids, free cholesterol, and albumin. Its overaccumulation is an infrequent cause of hyperlipidemia, which oftentimes presents in patients with cholestatic liver disease. Objective: to present the first two cases of patients with post-COVID cholangiopathy and LpX overaccumulation.
Case report: We present two female patients (i.e., a 34-year-old [patient 1] and a 56-year-old [patient 2]), who had complicated courses of COVID-19, requiring prolonged mechanical ventilation (>4 weeks). One month after discharge, patient 1 presented with abdominal pain. Patient 2 had gangrenous cholecystitis and later developed recurrent elevation of alkaline phosphatase and bilirubin. Both patients were diagnosed with cholestatic liver disease. During outpatient follow-up both patients were found to have elevated plasma LDL-C in routine lipid panels (723mg/dl and 1389mg/dl, respectively). Both patients underwent various treatments for elevated LDL-C before referral to endocrinology. Patients were diagnosed with LpX overaccumulation from post-COVID-19 cholangiopathy. In both patients, LDL-C fluctuations seen in routine lipid panels (affected by LpX levels) were tightly correlated with changes in alkaline phosphate and bilirubin.
Discussion: Our patients represent the first report of LpX overaccumulation in patients with post-COVID-19 cholangiopathy. Whether LpX accumulation is only the result of liver dysfunction, or COVID-19 infection plays a direct role in elevated LpX levels is still unknown.
Conclusion: In patients with complicated courses of COVID-19, LpX overaccumulation should be considered when a routine lipid panel shows significant LDL-C elevations. Awareness among healthcare providers regarding LpX is important to avoid unnecessary work-up and treatment.
Keywords: LDL; SARS-CoV-2; dyslipidemia; plasmapheresis; statins.
. 2023 Jan 7.
doi: 10.1016/j.aace.2023.01.001. Online ahead of print.
Hypercholesterolemia After Coronavirus Disease-19 (COVID-19): Time to Include Lipoprotein X among the Differential Diagnoses
Jennifer Girard[SUP] 1 [/SUP], Courtney Wagner[SUP] 1 [/SUP], Sujan Ravi[SUP] 2 [/SUP], Monica Agarwal[SUP] 3 4 [/SUP], Fernando Bril[SUP] 3 4 [/SUP]
Affiliations
- PMID: 36643829
- PMCID: PMC9824939
- DOI: 10.1016/j.aace.2023.01.001
Abstract
Background/objective: Lipoprotein X (LpX) is an abnormal lipoprotein composed of phospholipids, free cholesterol, and albumin. Its overaccumulation is an infrequent cause of hyperlipidemia, which oftentimes presents in patients with cholestatic liver disease. Objective: to present the first two cases of patients with post-COVID cholangiopathy and LpX overaccumulation.
Case report: We present two female patients (i.e., a 34-year-old [patient 1] and a 56-year-old [patient 2]), who had complicated courses of COVID-19, requiring prolonged mechanical ventilation (>4 weeks). One month after discharge, patient 1 presented with abdominal pain. Patient 2 had gangrenous cholecystitis and later developed recurrent elevation of alkaline phosphatase and bilirubin. Both patients were diagnosed with cholestatic liver disease. During outpatient follow-up both patients were found to have elevated plasma LDL-C in routine lipid panels (723mg/dl and 1389mg/dl, respectively). Both patients underwent various treatments for elevated LDL-C before referral to endocrinology. Patients were diagnosed with LpX overaccumulation from post-COVID-19 cholangiopathy. In both patients, LDL-C fluctuations seen in routine lipid panels (affected by LpX levels) were tightly correlated with changes in alkaline phosphate and bilirubin.
Discussion: Our patients represent the first report of LpX overaccumulation in patients with post-COVID-19 cholangiopathy. Whether LpX accumulation is only the result of liver dysfunction, or COVID-19 infection plays a direct role in elevated LpX levels is still unknown.
Conclusion: In patients with complicated courses of COVID-19, LpX overaccumulation should be considered when a routine lipid panel shows significant LDL-C elevations. Awareness among healthcare providers regarding LpX is important to avoid unnecessary work-up and treatment.
Keywords: LDL; SARS-CoV-2; dyslipidemia; plasmapheresis; statins.