Coronavirus causes hepatitis!
A woman was transferred to the emergency department at Northwell Health Hospital in New York, where her laboratory tests showed high levels of liver enzymes with a dark color of urine, then her temperature rose on the second day of her care so that doctors would then discover her infection with the new Coronavirus, according to a report of researchers from the hospital.This is the first documented case of a patient with COVID-19 who suffered acute hepatitis symptoms as the first symptom of the disease before respiratory symptoms appeared, according to the report, which was published on the website of the American Journal of Gastroenterology.
According to previous data on the disease, most of the early signs of COVID-19 infection are symptoms affecting the respiratory system such as fever, shortness of breath, sore throat and cough, in addition to pneumonia that is inferred by radiographs, although disruption of liver enzymes is not an uncommon symptom of the disease.
"COVID-19 should be included in the possible diagnoses of patients currently suffering from acute hepatitis," David Bernstein, head of the liver disease department at Northwell Health, told Medscape.
It is reported that Bernstein documented the case and reported on it in cooperation with the two doctors, Pranet Wander, a doctor in the Department of Hepatology at Northwell Hospital, and Maria Epstein, an infectious disease specialist at the same hospital.
According to Bernstein, Northwell Hospital currently has the highest number of COVID-19 infections in the state, and many patients show the traditional signs of coronavirus infection, along with the results of their analyzes showing disorders of liver enzymes, adding that his colleagues are elsewhere in the United States. They report similar cases.
Bernstein says: "It appears that elevated liver enzymes are an integral part of this disease,".
Status details
According to the case report, the 59-year-old woman who lives alone came to the emergency department with a major complaint about the dark color of urine. The patient was given a mask and isolated according to the protocol. "The patient did not suffer from coughing, sore throat, shortness of breath, diarrhea, nausea, vomiting, or abdominal pain, and denied any contact with those with HIV," wrote the officials responsible for documenting the case.
The patient suffers from a controlled infection with HIV, and the results of recent liver enzyme tests at an outpatient setting are normal. The patient was hospitalized eighteen hours after she reached the emergency department, due to doctors' concern about the high levels of her liver enzymes while she was HIV-positive.
On examination of the patient, her temperature reached 37.2 degrees without the presence of skin signs with normal pulmonary functions, and "no jaundice, or tenderness in the upper right quadrant of the abdomen, or hypertrophy of the liver or spleen" was observed.
The levels of liver enzymes are as follows:
Aminotransferase aspartate: 1230 IU / liter. Normal: Less than 50 IU / L.
Alanine aminotransferase: 697 IU / liter. The normal is less than 50 IU / L.
Alkaline phosphatase: 141 IU / L. Normal: less than 125 IU / L.
The results of hepatitis tests «A, B, C, D», CMV, and Epstein-Barr virus were all negative, as were the tests for respiratory viruses and autoimmune markers that came naturally.
The onset of fever on the second day
The patient's temperature rose to 39 degrees on the second day. A chest x-ray showed two-sided intracranial opacification.
Samples are taken from the pharynx and nose, and the results of a polymerase chain reaction test showed that they were infected with the emerging coronavirus. And she was given 3 liters of oxygen.
On the fourth day after hospitalization, the patient began five-day treatment doses that included 200 mg of hydroxychloroquine twice a day.
The patient was discharged after eight days in the hospital. The re-laboratory tests showed the following numbers:
Serum bilirubin level: 0.6 mg / dl.
Aminotransferase aspartate: 114 IU / L.
Alanine aminotransferase: 227 IU / liter.
Alkaline phosphatase: 259 IU / L.
According to Bernstein, it is difficult to track the sequence of symptoms of COVID-19, because individuals remain in their homes and do not come to the emergency department until the typical symptoms of COVID-19 appear, ignoring the rest of the symptoms that the virus can cause, and the above-mentioned patient's story confirms this idea. , As I came to the hospital with a complaint regarding the color of dark urine - an unexplained symptom - while “if she waited for the next day, she would have come because of a fever, so coincidence played her role so that we could examine the patient earlier.”
He added that he did not find any link between the patient's HIV and hepatic abnormalities or the diagnosis of COVID-19.
Most COVID-19 patients do not go to hospitals, which raises concern - according to Bernstein - because outpatient workers will not think of COVID-19 as one of the possible diagnoses for a patient with elevated liver enzymes.
If we can predict the course of the disease by increasing levels of liver enzymes, this may change laboratory data on how and where the disease is treated.
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