Coronavirus disease 2019 (COVID-19) first emerged in Wuhan, China, in December 2019 and THE World Health Organization (WHO) declared it a worldwide pandemic on March 11, 2020. It is a novel infectious disease causing respiratory illness, multiorgan failure (MOF), and death. Reports suggest only a small percentage of pediatric patients suffers from COVID-19 and is often milder in comparison to adults, however, can progress to severe disease in some cases. 

The present case reviewed an 11-year- old boy who was presented with fever and abdominal pain without improvement. The past medical history showed no significant findings. His condition deteriorated after two days with the increased respiratory rate was referred to the hospital and admitted to the pediatric ward. The fever did not subside, despite treatment and he developed yellowish discoloration of the skin and decreased level of consciousness. Therefore, he was transferred another facility with the impression of acute liver failure for liver transplantation. His vital signs were blood pressure 90/45, heart rate 135, respiratory rate 58, and Glasgow Coma scale (GCS) 6/15.

On physical examination, he had weak pulses. He was intubated a detailed history with his parents showed that they both had fever and cough with the history of international. In view of his findings of chest CT scan (bilateral ground glass), laboratory data, and positive real-time polymerase chain reaction (RT-PCR) of his parents and regardless of the negative oropharyngeal swab samples of the patient, the routine COVID-19 therapy including hydroxychloroquine plus lopinavir/ritonavir was initiated in combination with broad-spectrum antibiotics. The second specimen for COVID-19 was positive. Blood culture at PICU admission was negative, and the ceruloplasmin and ammonia levels were in the normal range. Nevertheless, his condition got worse due to refractory hypotension and decreased urine output and he suddenly experienced an atrial fibrillation (AF) and asystole without response to cardiopulmonary resuscitation (CPR) and died.

This case depicts a pediatric patient infected with COVID-19 that presented with acute hepatitis. The investigators evaluated viral hepatitis serology, hepatic auto-antibodies, 24 h urine, ceruloplasmin, and copper level to exclude other differential diagnoses.  Liver injury in patients with COVID-19 infection might be directly caused by a viral infection of liver cells. The current evidence revealed the possibility of viral infection in the liver. Therefore, it is essential to contemplate COVID-19 infection during any onset of acute hepatitis, even in pediatric patients.

Source: Saeed A, Shorafa E, Shahramian I. An 11-Year-Old Boy Infected with COVID-19 with Presentation of Acute Liver Failure. Hepat Mon. 20(6): e104415. Available at: https://sites.kowsarpub.com/hepatmon/articles/104415.html