Cellular and Molecular Gastroenterology and Hepatology (Jan 2021)

Findings of Hepatic Severe Acute Respiratory Syndrome Coronavirus-2 InfectionSummary

  • M. Isabel Fiel,
  • Siraj M. El Jamal,
  • Alberto Paniz-Mondolfi,
  • Ronald E. Gordon,
  • Jason Reidy,
  • Jela Bandovic,
  • Rashmi Advani,
  • Saikiran Kilaru,
  • Kamron Pourmand,
  • Stephen Ward,
  • Swan N. Thung,
  • Thomas Schiano

Journal volume & issue
Vol. 11, no. 3
pp. 763 – 770

Abstract

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Background & Aims: Liver injury due to coronavirus disease 2019 (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 2 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 severe acute respiratory syndrome coronavirus-2 S gene, and small sections from formalin-fixed paraffin-embedded liver tissue were processed for electron microscopy. Results: 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 severe acute respiratory syndrome coronavirus-2, the findings of which may indicate the possibility of direct cell injury. Conclusions: On the basis of the abundant apoptosis and severe cholangiocyte injury, these histopathologic changes suggest a direct cytopathic injury. Furthermore, some of the histopathologic changes may resemble acute cellular rejection occurring after liver transplantation. These 2 cases demonstrate that severe COVID-19 hepatitis can occur even in the absence of significant involvement of other organs.

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