Background The detection of severe acute respiratory syndrome coronavirus (SARS-CoV-2) is challenging, particularly in post-mortem human tissues. However, there is increasing evidence for viral SARS-CoV-2 manifestation in non-respiratory tissues. In this context, it is a current matter of debate, whether SARS-CoV-2 shows hepatotropism. Case presentation Here, we report a case of an 88-year-old women with massive SARS-CoV-2 viremia, severe jaundice and clinical signs of an acute hepatitis, who died within a few days from an acute liver failure without showing any clinical signs of pneumonia. Autopsy revealed a severe chronic and acute liver damage with bile duct infestation by SARS-CoV-2 that was accompanied by higher expressions of angiotensin-converting enzyme-2 (ACE2), Cathepsin L and transmembrane serine protease 2 (TMPRSS2). Conclusion Our findings indicate an enhanced biliary susceptibility to viral infection with SARS-CoV-2, that might have resulted from pre-existing severe liver damage. Furthermore, our findings emphasize the differential diagnosis of coronavirus disease 2019 (COVID-19)-associated liver failure in the clinical setting of an inexplicable jaundice.
【저자키워드】 COVID-19, SARS-CoV-2, Case report, Hepatitis, Bile duct, TMPRSS2, 【초록키워드】 coronavirus disease, viral infection, Coronavirus disease 2019, ACE2, coronavirus, Pneumonia, susceptibility, severe acute respiratory syndrome Coronavirus, Autopsy, Viral, Viremia, Hepatitis, Bile duct, Clinical signs, Post-mortem, women, respiratory, transmembrane serine protease 2, angiotensin-converting enzyme-2, expression, liver, differential diagnosis, acute liver failure, cathepsin, Angiotensin-converting enzyme, Liver damage, Evidence, angiotensin, liver failure, cathepsin L, acute hepatitis, acute respiratory syndrome, Serine, acute respiratory syndrome coronavirus, enzyme, transmembrane serine protease, human tissues, debate, clinical setting, jaundice, non-respiratory tissues, Clinical sign, died, accompanied, 【제목키워드】 SARS-COV-2 infection, Liver cirrhosis,