COVID-19-Triggered Acute Liver Failure and Rhabdomyolysis: A Case Report and Review of the Literature

Viruses. 2023 Jun 27;15(7):1445. doi: 10.3390/v15071445.

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.

Keywords: COVID-19; SARS-CoV-2 infection; acute liver failure; rhabdomyolysis; viral-induced acute liver failure; viral-induced rhabdomyolysis.

Publication types

  • Review
  • Case Reports

MeSH terms

  • Aspartate Aminotransferases
  • COVID-19* / complications
  • Humans
  • Liver Failure, Acute* / diagnosis
  • Liver Failure, Acute* / etiology
  • Male
  • Middle Aged
  • Rhabdomyolysis* / diagnosis
  • Rhabdomyolysis* / etiology
  • SARS-CoV-2

Substances

  • Aspartate Aminotransferases

Grants and funding

This research received no external funding.