Background and Aims
Liver injury due to COVID-19 is being increasingly recognized. Abnormal liver chemistry tests of varying severities occur in a majority of patients. However, there is a dearth of accompanying liver histologic studies in these patients. Methods: The current report details the clinical courses of two patients having severe COVID-19 hepatitis. Liver biopsies were analyzed under light microscopy, portions of liver tissue were hybridized with a target probe to the SARS-CoV-2 S gene, and small sections from formalin-fixed paraffin embedded liver tissue were processed for electron microscopy.
The liver histology of both cases showed a mixed inflammatory infiltrate with prominent bile duct damage, endotheliitis and many apoptotic bodies. In-situ hybridization and electron microscopy suggest the intrahepatic presence of the severe acute respiratory syndrome corona virus-2 (SARS-CoV-2), the findings of which may indicate the possibility of direct cell injury.
Based on the abundant apoptosis and severe cholangiocyte injury, these histopathological changes suggest a direct cytopathic injury. Furthermore, some of the histopathological changes may resemble acute cellular rejection occurring after liver transplantation. These two cases demonstrate that severe COVID-19 hepatitis can occur even in the absence of significant involvement of other organs.
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Conflict Of Interest: The authors have no conflict of interest.
Author contributions to manuscript:
Fiel – diagnosis, histology interpretation, concept, writing,
El Jamal – diagnosis by in-situ hybridization, writing
Paniz-Mondolfi – electron microscopy images interpretation, writing
Gordon – electron microscopy
Reidy – electron microscopy
Bandovic – histology and diagnosis
Advani – clinical history
Kilaru – clinical history
Pourmand – clinical care
Ward – histology interpretation
Thung – histology interpretation
Schiano – concept, writing of manuscript
© 2020 The Authors. Published by Elsevier Inc. on behalf of the AGA Institute.
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