P2487 - Hepatic Havoc: Acute Liver Failure Induced by the Dual Assault of COVID-19 & Influenza Infection

Saria Adnan Sultan, DO¹, Petro Shafranyuk, MD², Sana Saleem, MD¹, Nicholas Baur, DO³, Alex Yarbrough, DO^1
1Franciscan Health, Chicago, IL; ²Franciscan Health Olympia Fields, Olympia Fields, IL; ³Franciscan Health Olympia Fields, Chicago, IL

Introduction: Since the pandemic hit the world in 2020 we have seen how Covid-19, initially thought to be primarily a respiratory focused illness, present as systemic disease accompanied by numerous complications. ACE2 is a key receptor of the SARS-CoV-2 virus for cell entry. Many tissues involved in the GI tract, and others express this receptor, allowing us to see how detrimental this virus can be. Studies have shown that more robust strains of Influenza increase hepatocellular injury and hypertransaminasemia. Here we present a unique case of acute liver failure (ALF) warranting transplant evaluation in the absence of preexisting liver disease due to Covid-19 within the presence of Influenza B. Based on detailed literature review and to the best of our knowledge, there are no previous reports in literature of ALF lead caused by such a viral co-infection.

Case Description/Methods: A 31 year old female with a history of hypertension and peri-partum cardiomyopathy presented with worsening shortness of breath for three days. Upon arrival the patient was found to be Covid-19 and Influenza B positive. Patient underwent CT Angiogram Chest which was negative for PE but revealed potential pneumonia. Patient was started on Remdesivir, Tamiflu, steroids, and antibiotic therapy. Two days later the patient had a rapid response for altered mental status along with reported seizure-like activity. Later she was transferred to ICU for worsening encephalopathy. Liver profile results revealed ALT 1453 and AST 1539, which previously were within normal range. Patient’s autoimmune workup, viral hepatitis panel, and imaging were all unremarkable. Patients AST/ALT and INR continued to rise, and she developed progressive lethargy, consistent with Grade 2 hepatic encephalopathy. She was transferred to a tertiary center equipped with a transplant facility for liver transplantation evaluation.

Discussion: This unique case highlights the significance of COVID-19 and its potential to cause ALF in the setting of another viral co-infection, in this case the Influenza B strain. Not every patient who contracts COVID-19 or Influenza will experience liver injury or ALF, and the risk factors for developing such complications are not fully understood. It is crucial for healthcare providers to monitor liver function especially in patients who have coinfection of both COVID-19 and Influenza as their symptoms are ambiguous. If missed or not addressed in an opportune manner, timely transplant and effective therapeutic interventions can be delayed.


Disclosures:


Saria Adnan Sultan, DO¹, Petro Shafranyuk, MD², Sana Saleem, MD¹, Nicholas Baur, DO³, Alex Yarbrough, DO¹. P2487 - Hepatic Havoc: Acute Liver Failure Induced by the Dual Assault of COVID-19 & Influenza Infection, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.