Abstract
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.
Keywords: COVID-19; Hepatitis; Liver Biopsy; Liver Injury; Non-hepatotropic Virus; SARS-CoV-2.
【저자키워드】 COVID-19, SARS-CoV-2, Hepatitis, Liver injury, Liver Biopsy, Non-hepatotropic Virus, 【초록키워드】 coronavirus disease, SARS-CoV-2, Apoptosis, severe COVID-19, severity, Endotheliitis, Clinical course, Microscopy, Patient, Liver transplantation, light microscopy, histology, change, liver, patients, apoptotic bodies, In situ hybridization, Coronavirus-2, cellular, S gene, Inflammatory, Injury, acute respiratory syndrome, cell injury, other organs, liver tissue, formalin-fixed paraffin-embedded, rejection, probe, cytopathic, analyzed, hybridized, majority, absence, occur, processed, increasingly, histologic, intrahepatic, 【제목키워드】 respiratory, finding, hepatic,