Liver injury among the various manifestations of COVID-19 has gathered limelight in this era. Liver test abnormalities are found to be reported in ~15% of adult patients and those who are suffering from severe COVID-19 have shown higher rates of liver dysfunction. However, data regarding the prevalence of liver injury and the related clinical features in children with SARs-CoV-2 infection are limited.

There have been no reported pediatric cases of acute hepatitis occurring during the course of COVID-19. The present review appraised a case of a previously healthy 10-month-old boy who presented to Emergency Department with a two-day history of mild fever, rhinitis and cough. His mother had been diagnosed with SARs-CoV-2 infection a week earlier.

His physical examination showed that he was alert and responsive, normotensive and eupneic. His body temperature was 37.3°C with oxygen saturation in room air of 99%. He had no cutaneous manifestations, his lung and heart auscultation were normal. The abdomen was soft, and all signs of jaundice, hepatomegaly or splenomegaly were absent. 

Initial laboratory findings demonstrated significant increase of liver transaminases and ferritin. Serum bilirubin and albumin were normal and C-reactive protein was negative. Abdominal ultrasonography and full cardiological evaluation did not show any anomalies. Nasopharyngeal swab resulted positive for SARs-CoV-2 RNA. Blood cultures were negative and no coinfection was seen.

His body temperature came out to normal in the following day and liver enzymes started to decrease. Only supportive therapy was administered and was discharged after 6 days without any complications and without any requirement of respiratory support. At the follow-up visit, 2 weeks later, the child was asymptomatic, and all blood tests were normal.

Thus, the present case revealed an unreported correlation between acute SARs-CoV-2 infection and acute hepatitis in children, suggestive of the fact that assessment of liver enzymes during hospitalization for SARs-CoV-2 infection is indicated in pediatric age. The case also supported the evidence that coexistence of SARs-CoV-2 infection with respiratory symptoms is indicative of a viral-induced cytopathogenic effect in the liver maintained by the proven viral tropism for the liver.

Therefore, healthcare professionals should review SARs-CoV-2 as a probable cause of acute nonicteric hepatitis in children with mild respiratory symptoms. A close follow-up should be done in children with COVID-19 and liver abnormalities so as to exclude the possibility of long-term impact of SARs-CoV-2 on the liver.

Source: Brisca G, Mallamaci M, Tardini G, Martino L, Chianucci B, Ricci M, Buffoni I, Romanengo M. SARS-CoV-2 Infection May Present as Acute Hepatitis in Children. Pediatr Infect Dis J. 2021 May 1;40(5):e214-e215.