To our knowledge, this is the first report of an acute icteric hepatitis as the first and isolated sign of COVID-19 in a previously healthy patient. This is very unlikely because there are strict hygiene measures in the department, the patient stayed in a single room and no other patient in the observation unit tested positive for COVID-19 on that day. 5 As the patient spent one night in the ED, the hypothesis of nosocomial COVID-19 was also mentioned. In addition, the patient presented with anosmia, a typical symptom of COVID-19. These must report a sensitivity ≥80% and specificity >99% in symptomatic subjects. The risk of a false positive result on the COVID-19 antigen test is low because to be implemented, such tests must comply with the clinical performance criteria defined by the French National Authority for Health ( Haute Autorité de Santé). However, even if screening for usual viral hepatitis has been repeated and was negative, a later seroconversion cannot be formally excluded. Blood cultures and screening for autoimmune hepatitis markers (antinuclear, antisoluble liver antigen, antismooth muscle, antimitochondrial, antiliver cytosol, antiliver kidney microsomal and antigastric parietal cell antibodies) were also negative.Īs other causes of acute hepatitis were ruled out, it seemed highly probable that acute hepatitis was directly caused by COVID-19.
The following serological tests were performed and all came back negative (no antibodies or immunity): hepatitis A, B, C, D, E, EBV, CMV, HIV, HSV1, HSV2, HHV6, HHV8, parvovirus B19, leptospirosis and listeria. As the patient spent the night in the ED observation unit, a nasopharyngeal swab was done and RT-PCR was negative for COVID-19. Abdominal ultrasound with Doppler showed normal liver and gallbladder with a patent portal and hepatic circulation.
Liver function tests read as follows: aspartate aminotransferase 1366 IU/L (normal 100%.
Investigations and differential diagnosisĬomplete blood count was normal including absolute lymphocyte count (1650 cells/mm 3), and inflammatory markers (C reactive protein and procalcitonin) were negative.
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