Acute on Chronic Liver Failure From Novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)

He Qiu; Praneet Wander; David Bernstein; Sanjaya K. Satapathy


Liver International. 2020;40(7):1590-1593. 

In This Article

Abstract and Introduction


The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a highly infectious viral disease that predominantly causes respiratory symptoms. Elevated liver enzymes have been reported during the course of disease and appear to be common. We present a 56-year-old woman with a history of decompensated alcoholic cirrhosis who presented with abdominal pain, fever and diarrhoea and was found to have acute on chronic liver failure secondary to SARS-CoV-2 infection. The patient was treated with empiric antibiotic and supportive care with subsequent improvement.


The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of a worldwide pandemic affecting more than 200 countries. There have been greater than 1 million cases worldwide with the overall case fatality rate (CFR) ranging between 0.4% and 7.7%.[1] The clinical spectrum of SARS-CoV-2 infection ranges from asymptomatic to mild lower respiratory syndrome, acute respiratory distress syndrome (ARDS) requiring mechanical ventilation and multiple organ failure.[2] The most common clinical manifestations include fever, fatigue, dry cough, dyspnoea, anosmia, loss of taste and myalgia.[3] Other atypical presentations include nausea, vomiting and/or diarrhoea.[3] Typically, laboratory findings include leucocytosis, lymphopenia, elevated lactate dehydrogenase (LDH), elevated C-reactive protein (CRP), elevated erythrocyte sedimentation rate (ESR), elevated ferritin and elevated aminotransferases. We present a case of acute on chronic liver failure caused by SARS-CoV-2 infection in a patient with decompensated alcoholic cirrhosis.