tetano
Editor, Senior Moderator
Arch Pathol Lab Med
. 2022 Jun 3.
doi: 10.5858/arpa.2021-0605-SA. Online ahead of print.
Persistent Cholestatic Injury and Secondary Sclerosing Cholangitis in COVID-19 Patients
Angela R Shih[SUP] 1 [/SUP], Dilara Hatipoglu[SUP] 2 [/SUP], Robert Wilechansky[SUP] 3 2 [/SUP], Reece Goiffon[SUP] 4 [/SUP], Vikram Deshpande[SUP] 1 [/SUP], Joseph Misdraji[SUP] 1 [/SUP], Raymond T Chung[SUP] 3 2 [/SUP]
Affiliations
Abstract
Context.–: Coronavirus disease 2019 (COVID-19) has been associated with liver injury, and a small subset of patients recovering from severe disease have shown persistent markedly elevated liver biochemistries for months after infection.
Objective.–: To characterize persistent biliary injury after COVID-19.
Design.–: A search of the pathology archives identified 7 post-COVID-19 patients with persistent biliary injury, and the clinical, radiologic, and pathologic features were assessed.
Results.–: All patients in this cohort presented with respiratory symptoms and had a complicated clinical course with acute elevation of liver biochemistries. Alkaline phosphatase (ALP) was markedly and persistently elevated after discharge (median peak ALP: 1498 IU/L, at a median of 84 days from diagnosis). Magnetic resonance cholangiopancreatography (MRCP) showed 3 patients with irregularity, stricturing, and dilatation of intrahepatic ducts; no radiographic abnormalities were identified in the remaining 4 patients. Liver biopsies showed mild portal changes with features of cholestatic injury in 4 patients (bile duct injury and canalicular cholestasis) and marked biliary obstruction in 2 patients (profound cholestasis, ductular reaction, and bile infarcts), but no SARS-CoV-2 ribonucleic acid (RNA) was identified on in-situ hybridization. On follow-up, most patients had minimal intervention and showed marked improvement of liver biochemistries but with mild persistent elevation of ALP.
Conclusions.–: A subset of critically ill COVID-19 patients demonstrates marked and persistent cholestatic injury, with radiographic and histologic evidence of secondary sclerosing cholangitis, suggesting that cholestatic liver disease and secondary sclerosing cholangitis may be long-term sequelae of COVID-19 acute illness as a longstanding manifestation of critical illness.
. 2022 Jun 3.
doi: 10.5858/arpa.2021-0605-SA. Online ahead of print.
Persistent Cholestatic Injury and Secondary Sclerosing Cholangitis in COVID-19 Patients
Angela R Shih[SUP] 1 [/SUP], Dilara Hatipoglu[SUP] 2 [/SUP], Robert Wilechansky[SUP] 3 2 [/SUP], Reece Goiffon[SUP] 4 [/SUP], Vikram Deshpande[SUP] 1 [/SUP], Joseph Misdraji[SUP] 1 [/SUP], Raymond T Chung[SUP] 3 2 [/SUP]
Affiliations
- PMID: 35657750
- DOI: 10.5858/arpa.2021-0605-SA
Abstract
Context.–: Coronavirus disease 2019 (COVID-19) has been associated with liver injury, and a small subset of patients recovering from severe disease have shown persistent markedly elevated liver biochemistries for months after infection.
Objective.–: To characterize persistent biliary injury after COVID-19.
Design.–: A search of the pathology archives identified 7 post-COVID-19 patients with persistent biliary injury, and the clinical, radiologic, and pathologic features were assessed.
Results.–: All patients in this cohort presented with respiratory symptoms and had a complicated clinical course with acute elevation of liver biochemistries. Alkaline phosphatase (ALP) was markedly and persistently elevated after discharge (median peak ALP: 1498 IU/L, at a median of 84 days from diagnosis). Magnetic resonance cholangiopancreatography (MRCP) showed 3 patients with irregularity, stricturing, and dilatation of intrahepatic ducts; no radiographic abnormalities were identified in the remaining 4 patients. Liver biopsies showed mild portal changes with features of cholestatic injury in 4 patients (bile duct injury and canalicular cholestasis) and marked biliary obstruction in 2 patients (profound cholestasis, ductular reaction, and bile infarcts), but no SARS-CoV-2 ribonucleic acid (RNA) was identified on in-situ hybridization. On follow-up, most patients had minimal intervention and showed marked improvement of liver biochemistries but with mild persistent elevation of ALP.
Conclusions.–: A subset of critically ill COVID-19 patients demonstrates marked and persistent cholestatic injury, with radiographic and histologic evidence of secondary sclerosing cholangitis, suggesting that cholestatic liver disease and secondary sclerosing cholangitis may be long-term sequelae of COVID-19 acute illness as a longstanding manifestation of critical illness.