Long COVID-19 Liver Manifestation in Children : Journal of Pediatric Gastroenterology and Nutrition
long covid 19 liver manifestation in children : journal of pediatric

Long COVID-19 Liver Manifestation in Children : Journal of Pediatric Gastroenterology and Nutrition


Objectives: 

SARS CoV-2, the novel coronavirus responsible for coronavirus disease (COVID-19), has been a major cause of morbidity and mortality worldwide. Gastrointestinal and hepatic manifestations during acute disease have been reported extensively in the literature. Post-COVID-19 cholangiopathy has been increasingly reported in adults. In children, data are sparse. Our aim was to describe pediatric patients who recovered from COVID-19 and later presented with liver injury.

Methods: 

This is a retrospective case-series study of pediatric patients with post-COVID-19 liver manifestations. We collected data on demographics, medical history, clinical presentation, laboratory results, imaging, histology, treatment, and outcome.

Results: 

We report five pediatric patients who recovered from COVID-19 and later presented with liver injury. Two types of clinical presentation were distinguishable. Two infants aged 3 and 5 months, previously healthy, presented with acute liver failure that rapidly progressed to liver transplantation. Their liver explant showed massive necrosis with cholangiolar proliferation and lymphocytic infiltrate. Three children, two aged 8 years and one aged 13 years, presented with hepatitis with cholestasis. Two children had a liver biopsy significant for lymphocytic portal and parenchyma inflammation, along with bile duct proliferations. All three were started on steroid treatment; liver enzymes improved, and they were weaned successfully from treatment. For all five patients, extensive etiology workup for infectious and metabolic etiologies were negative.

Conclusions: 

We report two distinct patterns of potentially long COVID-19 liver manifestations in children with common clinical, radiological, and histopathological characteristics after a thorough workup excluded other known etiologies.

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