PDF(Pubmed)
Abstract：
COVID-19 is primarily known for its respiratory tract involvement, often leading to severe pneumonia and exacerbation of underlying diseases. However, emerging evidence suggests that COVID-19 can result in multiorgan failure, affecting organs beyond the respiratory system. We present the case of a 62-year-old male with COVID-19 who developed acute liver failure (ALF) and rhabdomyolysis in the absence of respiratory failure. Initially, the patient presented with significantly elevated aspartate transaminase (5398 U/L) and alanine transaminase (2197 U/L) levels. Furthermore, a prolonged prothrombin time international normalized ratio (INR) of 2.33 indicated the diagnosis of ALF without hepatic coma, according to Japanese diagnostic criteria. The patient also exhibited elevated creatine kinase (9498 U/L) and a mild increase in creatinine (1.25 mg/dL) levels, but both values improved with intravenous fluid support and molnupiravir administration. To our knowledge, this is the first reported case presenting with both ALF and rhabdomyolysis associated with COVID-19. In addition, we review the existing literature to summarize previously reported cases of ALF triggered by SARS-CoV-2. This case report underscores the significance of recognizing COVID-19 as a significant contributing factor in the development of multiorgan failure. Furthermore, it suggests that COVID-19 can lead to severe illness, irrespective of the absence of respiratory failure.
摘要：
COVID-19主要以其呼吸道参与而闻名，通常导致严重的肺炎和基础疾病的恶化。然而,新出现的证据表明，COVID-19可导致多器官衰竭，影响呼吸系统以外的器官。我们介绍了一名62岁的COVID-19男性在没有呼吸衰竭的情况下发展为急性肝功能衰竭（ALF）和横纹肌溶解症的病例。最初，患者的天冬氨酸转氨酶(5398U/L)和丙氨酸转氨酶(2197U/L)水平显著升高.此外，延长的凝血酶原时间国际标准化比率（INR）为2.33表明诊断为无肝昏迷的ALF，根据日本的诊断标准。患者还表现出肌酸激酶升高（9498U/L）和肌酐水平轻度升高（1.25mg/dL），但这两个值改善与静脉输液支持和molnupiravir管理。据我们所知,这是报告的首例同时出现与COVID-19相关的ALF和横纹肌溶解症的病例.此外,我们回顾了现有的文献，以总结以前报道的SARS-CoV-2引发的ALF病例。该病例报告强调了承认COVID-19是多器官衰竭发展的重要促成因素的重要性。此外，这表明COVID-19可能导致严重的疾病，无论是否没有呼吸衰竭。
