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07 July 2022 : Case report  Brazil

[In Press] Post-COVID-19 Secondary Sclerosing Cholangitis: A Rare but Severe Condition with no Treatment Besides Liver Transplantation

Challenging differential diagnosis, Unusual setting of medical care, Rare disease

Marcel Cerqueira Cesar Machado1ABEF, Roberto Kalil Filho2E, Ibrahim Ahmad Hussein el Bacha3BF, Irai Santana de Oliveira4CD, Cristiane Maria de Freitas Ribeiro5CD, Heraldo Possolo de Souza1DE, Edson Roberto Parise6CD

DOI: 10.12659/AJCR.936250

Am J Case Rep In Press; DOI: 10.12659/AJCR.936250  

Available online: 2022-07-07, In Press, Corrected Proof

Publication in the "In-Press" formula aims at speeding up the public availability of the pending manuscript while waiting for the final publication. The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule

Abstract

BACKGROUND
The incidence of abnormal liver function, mainly aspartate aminotransferase and alanine aminotransferase elevations, in patients with COVID-19 is not uncommon, but persistent liver damage after the acute phase of the disease is uncommon and has been recently recognized as a new entity named post-COVID-19 cholangiopathy.
CASE REPORT
We report a clinical case with progressive cholestatic disease following severe COVID-19. AST and ALT peaked at hospital admission and while its serum concentration went down, bilirubin and cholestatic liver enzymes started to increase, reaching the maximum at day 122. Magnetic resonance imaging (MRI) revealed a diffuse irregularity of intra- and extrahepatic bile ducts, with multiple focal strictures alternating with mild focal dilations of the biliary tree, suggesting a sclerosing cholangiopathy. A transjugular liver biopsy showed a prominent bile ductular reaction, cholangiocyte injury, inflammatory infiltrate rich in neutrophils, biliary infarctions, marked cholestasis, and portal fibrosis, suggesting the diagnosis of post-Covid-19 secondary sclerosing cholangitis. The patient evolved with a continuous deterioration of liver functions, but liver transplantation was not performed due to his poor clinical condition.
CONCLUSIONS
Post-COVID-19 SSC is a severe disease with no effective clinical treatment and has liver transplantation as the only treatment for a few selected patients.

Keywords: Cholangitis, Sclerosing; Cholestasis, Intrahepatic; Adult Multisystem Inflammatory Disease; COVID-19 Related

SARS-CoV-2/COVID-19

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923