Thirteen-Year Follow-Up of a Patient with Liver Cirrhosis Resulting from the Overlap Syndrome of Autoimmune Hepatitis and Primary Biliary Cholangitis: Severe COVID-19 and Liver Transplantation
https://doi.org/10.22416/1382-4376-2024-34-1-76-84
Abstract
Aim: to present the difficulties of long-term management of a patient with liver cirrhosis in the outcome of overlap syndrome (autoimmune hepatitis and primary biliary cholangitis) who suffered from severe COVID-19 infection.
Key points. The diagnosis of liver cirrhosis as an outcome of overlap syndrome (autoimmune hepatitis and primary biliary cholangitis) was established at the patient’s age of 33 years. At the age of 40, the patient became pregnant for the first time, the pregnancy proceeded well, and a cesarean section was performed at 36 weeks. At the age of 45, the patient suffered a severe new coronavirus infection, followed by decompensation of liver cirrhosis, which required liver transplantation 4 months after COVID-19, followed by a favorable postoperative course.
Conclusion. This clinical case demonstrates the successful onset and outcome of pregnancy in a patient with liver cirrhosis in the outcome of overlap syndrome (autoimmune hepatitis and primary biliary cholangitis). The pronounced activity of the disease after severe new coronavirus infection required liver transplantation with successful outcome.
About the Authors
A. Kh. OdintsovaRussian Federation
Alfiya Kh. Odintsova — Cand. Sci. (Med.), Head of the Gastroenterology Department
420064, Kazan, Orenburgskiy highroad, 138
D. R. Akberova
Russian Federation
Dilyara R. Akberova — Cand. Sci. (Med.), Teaching Assistant at the Department of Hospital Therapy
420012, Kazan, Butlerova str., 49
L. R. Sadykova
Russian Federation
Leila R. Sadykova — Gastroenterologist at the Department of Gastroenterology
420064, Kazan, Orenburgskiy highroad, 138
N. A. Cheremina
Russian Federation
Natalia A. Cheremina — Gastroenterologist at the Department of Gastroenterology
420064, Kazan, Orenburgskiy highroad, 138
M. M. Minnullin
Russian Federation
Marsel M. Minnullin — Minister of Health
420012, Kazan, Butlerova str., 40/11
A. A. Kirshin
Russian Federation
Aleksandr A. Kirshin — Deputy Chief Physician
420029, Kazan, Sibirskiy highroad, 29
E. N. Gabitova
Russian Federation
Elena N. Gabitova — Gastroenterologist at the Department of Gastroenterology
420064, Kazan, Orenburgskiy highroad, 138
A. Yu. Khasanshina
Russian Federation
Alina Yu. Khasanshina — Gastroenterologist at the Department of Gastroenterology
420064, Kazan, Orenburgskiy highroad, 138
D. I. Abdulganieva
Russian Federation
Diana I. Abdulganieva — Dr. Sci. (Med.), Professor, Head of the Department of Hospital Therapy, Kazan State Medical University
420012, Kazan, Butlerova str., 49
References
1. Abdulganieva D.I., Odintsova A. Kh., Mukhametova D.D., Cheremina N.A. Family cases of autoimmune liver disease. Effective pharmacotherapy. 2019;15(28);62–5. (In Russ.). DOI: 10.33978/2307-3586-2019-15-28-62-65
2. Casas O.Y., Ramírez G.S., Zuluaga J.I., Santos Ó., Maya O.M., Gómez J.H., et al. Autoimmune hepatitis — primary biliary cholangitis overlap syndrome. Longterm outcomes of a retrospective cohort in a university hospital. Gastroenterol Hepatol. 2018;41(9):544–52. DOI: 10.1016/j.gastrohep.2018.05.019
3. Zeng Q., Zhao L., Wang C., Gao M., Han X., Chen C., et al. Relationship between autoimmune liver disease and autoimmune thyroid disease: A cross-sectional study. Scand J Gastroenterol. 2020;55(2):216–21. DOI: 10.1080/00365521.2019.1710766
4. Liu C., Wang Y.L., Yang Y.Y., Zhang N.P., Niu C., Shen X.Z., et al. Novel approaches to intervene gut microbiota in the treatment of chronic liver diseases. FASEB J. 2021;35(10):e21871. DOI: 10.1096/fj.202100939R
5. Grinevich V.B., Kravchuk Yu.A., Ped V.I., Sas E.I., Salikova S.P., Gubonina I.V., et al. Management of patients with digestive diseases during the COVID-19 pandemic: Clinical practice guidelines by the Gastroenterological Scientific Society of Russia. Experimental and Clinical Gastroenterology. 2020;179(7):4–51. (In Russ.). DOI: 10.31146/1682-8658-ecg-179-7-4-51
6. Efe C., Dhanasekaran R., Lammert C., Ebik B., Higuerade la Tijera F., Aloman C., et al. Outcome of COVID-19 in patients with autoimmune hepatitis: An international multicenter study. Hepatology. 2021;73(6):2099–109. Erratum in: Hepatology. 2022;75(3):774. DOI: 10.1002/hep.31797
7. Zaky S., Alboraie M., El Badry M., Metwally M.A., Abdelaziz A., Fouad Y., et al. Management of liver disease patients in different clinical situations during COVID-19 pandemic. Egypt Liver J. 2021;11(1):21. DOI: 10.1186/s43066-021-00091-x
8. Marjot T., Moon A.M., Cook J.A., Abd-Elsalam S., Aloman C., Armstrong M.J., et al. Outcomes following SARS-CoV-2 infection in patients with chronic liver disease: An international registry study. J Hepatol. 2021;74(3):567–77. DOI: 10.1016/j.jhep.2020.09.024
9. Vuppalanchi V., Gelow K., Green K., Vuppalanchi R., Lammert C. Behaviors, symptoms, and outcomes of North American patients with autoimmune hepatitis during the COVID-19 pandemic. J Investig Med. 2021;69(8):1426– 33. DOI: 10.1136/jim-2021-001871
10. Mukhametova D.D., Bodryagina E.S., Odintsova A. Kh., Kupkenova L.M., Shafikova D.F., Fontenelle B.M., et al. A clinical case of infliximab induction in a patient with Crohn's disease and acute new coronavirus infection. Practical Medicine. 2023;21(3):121–4. (In Russ.).
11. Nurullina G.I., Khalfina T.N., Islamova G.M., Sagitova A.S., Krasnova L.A. Clinical case of acute kidney injury in a patient with COVID-19. Practical Medicine. 2022;20(1):129–32. (In Russ.). DOI: 10.32000/2072-1757-2022-1-129-132
12. Hao S.R., Zhang S.Y., Lian J.S., Jin X., Ye C.Y., Cai H., et al. Liver enzyme elevation in coronavirus disease 2019: A multicenter, retrospective, cross-sectional study. Am J Gastroenterol. 2020;115(7):1075–83. DOI: 10.14309/ajg.0000000000000717
13. Kukla M., Skonieczna-Żydecka K., Kotfis K., Maciejewska D., Łoniewski I., Lara L.F., et al. COVID-19, MERS and SARS with concomitant liver injury — systematic review of the existing literature. J Clin Med. 2020;9(5):1420. DOI: 10.3390/jcm9051420
14. Ridruejo E., Soza A. The liver in times of COVID-19: What hepatologists should know. Ann Hepatol. 2020;19(4):353– 8. DOI: 10.1016/j.aohep.2020.05.001
15. Wang Y., Liu S., Liu H., Li W., Lin F., Jiang L., et al. SARS-CoV-2 infection of the liver directly contributes to hepatic impairment in patients with COVID-19. J Hepatol. 2020;73(4):807–16. DOI: 10.1016/j.jhep.2020.05.002
16. Moon A.M., Webb G.J., Aloman C., Armstrong M.J., Cargill T., Dhanasekaran R., et al. High mortality rates for SARS-CoV-2 infection in patients with pre-existing chronic liver disease and cirrhosis: Preliminary results from an international registry. J Hepatol. 2020;73(3):705–8. DOI: 10.1016/j.jhep.2020.05.013
17. Nasa P., Alexander G. COVID-19 and the liver: What do we know so far? World J Hepatol. 2021;13(5):522–32. DOI: 10.4254/wjh.v13.i5.522
18. Ismailova A.G., Maslennikov R.V., Zharkova M.S., Ivashkin V.T. Impact of novel coronavirus infection on the course and prognosis of cirrhosis. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2023;33(6):65–80. (In Russ.). DOI: 10.22416/1382-4376-2023-33-6-65-80
19. Limon-De La Rosa N., Cervantes-Alvarez E., Navarro-Alvarez N. Increased hepatic expression of SARSCoV-2 entry points and proinflammatory cytokines in cirrhosis. Clin Gastroenterol Hepatol. 2022;20(1):239–41.e3. DOI: 10.1016/j.cgh.2021.08.053
20. Seow J.J.W., Pai R., Mishra A., Shepherdson E., Lim T.K.H., Goh B.K.P. Single-cell RNA-seq reveals angiotensin-converting enzyme 2 and transmembrane serine protease 2 expression in TROP2+ liver progenitor cells: Implications in coronavirus disease 2019-associated liver dysfunction. Front Med (Lausanne). 2021;8:603374. DOI: 10.3389/fmed.2021.603374
21. Prashnova M.K., Raikhelson K.L., Marchenko N.V., Zakharenko S.M. COVID-19 in patients with primary biliary cholangitis. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2022;32(3):29–34. (In Russ.). DOI: 10.22416/1382-4376-2022-32-3-29-34
22. Kulkarni A.V., Parthasarathy K., Kumar P., Sharma M., Reddy R., Chaitanya Akkaraju Venkata K., et al. Early liver transplantation after COVID-19 infection: The first report. Am J Transplant. 2021;21(6):2279–84. DOI: 10.1111/ajt.16509
23. Silveira P.G., Mehra M.R., Teuteberg J., Benza R., Benden M.M., Budev M., et al. Guidance from the International Society of Heart and Lung Transplantation regarding the SARS CoV-2 pandemic. URL: https://www.inshlt.org/wp-content/uploads/2021/covid-19.pdf
Supplementary files
Review
For citations:
Odintsova A.Kh., Akberova D.R., Sadykova L.R., Cheremina N.A., Minnullin M.M., Kirshin A.A., Gabitova E.N., Khasanshina A.Yu., Abdulganieva D.I. Thirteen-Year Follow-Up of a Patient with Liver Cirrhosis Resulting from the Overlap Syndrome of Autoimmune Hepatitis and Primary Biliary Cholangitis: Severe COVID-19 and Liver Transplantation. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2024;34(1):76-84. https://doi.org/10.22416/1382-4376-2024-34-1-76-84