Persistent Thrombocytopenia and Liver Function Findings in Covid-19 Infection in Patients with Hepatic Cirrhosis: A Case Report

Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) has devastating effects on various organs; one of them is significant damage to cholangiocytes and hepatocytes. SARS-CoV-2 infection might contribute to hepatic impairment by direct or secondary damage to hepatocytes. We report a 22-year-old man with cirrhosis and hepatitis B infection since 2016. He presented with hematochezia and a productive cough, and abdominal examination revealed hypersplenism. The laboratory tests showed thrombocytopenia, elevated Serum Glutamic-Oxaloacetic Transaminase (SGOT), elevated bilirubin, prolonged Prothrombhin Time (PT), prolonged Activated Partial Thrombhoplastin Time (APTT), and elevated International Normalized Ratio (INR). The patient underwent SARS-CoV-2 Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) testing and was confirmed to have mild coronavirus disease 2019 (COVID-19). The patient was diagnosed with liver cirrhosis, Child-Turcotte-Pugh (CTP-A), chronic hepatitis B, grade I oesophageal varices, mild portal hypertensive gastropathy, thrombocytopenia, hematochezia, ecchymosis, and mild COVID-19. This case report highlights the potential contribution of SARS-CoV-2 infection to worsening thrombocytopenia and bilirubin abnormalities in a patient with preexisting liver cirrhosis. Further studies are needed to clarify the interaction between COVID-19 and chronic liver disease.

Keywords: COVID-19, SARS-CoV-2, Liver cirrhosis, Thrombocytopenia, Chronic hepatitis B, Liver injury