https://pubmed.ncbi.nlm.nih.gov/35687535/ Covid-19
J Pediatr Gastroenterol Nutr
. 2022 Sep 1;75(3):244-251.
doi: 10.1097/MPG.0000000000003521.Epub 2022 Aug 9.
Long COVID-19 Liver Manifestation in Children

Shiri Cooper 1 2, Ana Tobar 2 3, Osnat Konen 2 4, Naama Orenstein 2 5, Nesia Kropach Gilad 2 5, Yuval E Landau 2 6, Yael Mozer-Glassberg 1 2, Michal Rozenfeld Bar-Lev 1 2, Ron Shaoul 7, Raanan Shamir 1 2, Orith Waisbourd-Zinman 1 2

Affiliations expand
PMID: 35687535

DOI: 10.1097/MPG.0000000000003521

Abstract

Objectives: Severe acute respiratory syndrome coronavirus 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 5 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, 2 aged 8 years and 1 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 3 were started on steroid treatment; liver enzymes improved, and they were weaned successfully from treatment. For all 5 patients, extensive etiology workup for infectious and metabolic etiologies was negative.

Conclusions: We report 2 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.