Severe Hepatitis in Pediatric Coronavirus Disease 2019.
Severe Hepatitis in Pediatric Coronavirus Disease 2019.
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DOI：
10.1097/mpg.0000000000003404
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发表时间：
2022-05-01
影响因子：
2.9
通讯作者：
Chapin, Catherine A.
中科院分区：
文献类型：
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作者：
Antala, Swati;Diamond, Tamir;Kociolek, Larry K.;Shah, Amit A.;Chapin, Catherine A.
2019 年冠状病毒病 (COVID-19) 肝脏受累的典型特征是儿童合成功能保留的轻度肝炎。重症肝炎是一种罕见的 COVID-19 感染并发症，在儿科人群中尚未得到广泛描述。我们报告了一个由四名先前健康的儿童组成的病例系列，这些儿童以严重肝炎为 COVID-19 感染的主要表现。其中两名患者符合急性肝衰竭的标准。没有患者出现呼吸道症状。一名患者被发现存在补体功能障碍，导致微血管病变特征，并使用依库丽单抗成功治疗。该病例与成人尸检数据一致，表明继发于 COVID-19 感染的更严重的肝功能障碍病例可能与补体激活和微血管病变特征有关。对于重症 COVID-19 病例，应评估肝功能，即使患者没有明显的呼吸道或其他全身症状，严重急性呼吸综合征冠状病毒 2 感染也应被视为急性重症肝炎的原因。
Hepatic involvement in coronavirus disease 2019 (COVID-19) is typically characterized as mild hepatitis with preserved synthetic function in children. Severe hepatitis is a rare complication of COVID-19 infection that has not been extensively described in the pediatric population. We report a case series of four previously healthy children who presented with significant hepatitis as the primary manifestation of COVID-19 infection. Two of these patients met criteria for acute liver failure. None of the patients had respiratory symptoms. One patient was found to have complement dysfunction resulting in microangiopathic features and was treated successfully with eculizumab. This case is in line with adult post-mortem data showing that more severe cases of hepatic dysfunction secondary to COVID-19 infection may be associated with complement activation and microangiopathic features. Liver function should be evaluated in cases of severe COVID-19, and severe acute respiratory syndrome coronavirus 2 infection should be considered as a cause of acute severe hepatitis even in patients without significant respiratory or other systemic symptoms.