Coronavirus disease 2019 (COVID-19), a novel emerging disease that is still not fully characterized. Its etiology is severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel virus that can be transmitted easily from human to human mainly by the respiratory route. However, there is no precise treatment available for COVID-19 or a vaccine for prevention. The disease has wide spectrum ranging from nonspecific symptoms such as fever, headache, and fatigue, along with respiratory symptoms including cough and dyspnea and other systemic involvement. Severe manifestations of these patients were related to hemophagocytic syndrome and cytokine storm due to altered immune response. Patients with severe disease were reported to have increased liver enzymes and various mechanisms are known to be implicated in the pathogenesis of the disease.

The current case reported an unusual case of SARS-CoV-2 infection in a 24-year-old man without any record of previous medical illness. The patient presented with mild respiratory involvement and had no serious hepatic manifestation during the disease course. Nevertheless, he experienced acute fulminant hepatitis B infection and cytokine release syndrome that caused multiorgan failure and death.

The particular case showed that though it is infrequent for SARS-CoV-2 infection with mild respiratory symptoms can cause severe systemic disease and organ failure, it made it an rare case of acute hepatitis B infection with concomitant SARS-CoV-2 resulting in fulminant hepatitis, multiorgan failure, and death.

Source: Ali E, Ziglam H, Kohla S, Ahmed M, Yassin M. A Case of Fulminant Liver Failure in a 24-Year-Old Man with Coinfection with Hepatitis B Virus and SARS-CoV-2. Am J Case Rep. 2020 Oct 13;21:e925932.