The emergence of severe acute respiratory syndrome corona virus 2 (SARS-CoV-2), as a novel pathogen, has changed the concept of infectious diseases. Literature has described immune-mediated post-infectious complications for other pathogens in the past, but they remain relatively rare occurrences. The corona virus disease 2019 (COVID-19) pandemic has challenged the infectious diseases practitioners and colleagues from related specialties to maintain a double focus–managing the acute disease per se, while also keeping an eye towards post-COVID complications.

A report describes a case of post-corona virus disease (COVID) immune hepatitis occurring in a young male with no pre-existing co morbidities.  

A previously healthy 21-year-old male patient got hospitalized with mild COVID-19. During in-hospital isolation and monitoring, he developed an increase in the levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST), along with the enzymes peaking at day 24 (ALT 15 times the upper normal limit), with preserved liver function. The increase in liver enzyme was observed 20 d after the complete clinical remission of COVID-19, with ALT dynamics paralleling the increase in total antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). 

The case was thus interpreted as post-COVID immune hepatitis, with extensive laboratory investigations to rule out other potential causes. 

The doctors continued to monitor the patient closely over the next few days until the ALT and AST levels showed a decrease. After the observed decrease in ALT and AST levels, the patient was rendered a discharge on day 27, since the clinical remission and RT-PCR negative conversion criteria had been already met, and he continued to be followed up as an outpatient. 

The complete remission of hepatocytolysis was observed 20 d after the peak ALT, without further intervention, with complete recovery. But the total anti-SARS-CoV-2 antibodies was observed to continue to increase the next 5 months following the acute infection reaching a peak of 865 S/CO at day 145 and then gradually decreasing to 657 S/CO at day 193 (6 months after the initial infection).

Thus it was advised to closely monitor young patients with mild forms of the disease, and a high index of suspicion should be maintained for post-COVID complications.

Source: World J Clin Cases 2021; 9(16): 4032-4039 [PMID: 34141763 DOI: 10.12998/wjcc.v9.i16.4032]