Findings of Hepatic Severe Acute Respiratory Syndrome Coronavirus-2 Infection

M. Isabel Fiel, Siraj M. El Jamal, Alberto Paniz-Mondolfi, Ronald E. Gordon, Jason Reidy, Jela Bandovic, Rashmi Advani, Saikiran Kilaru, Kamron Pourmand, Stephen Ward, Swan N. Thung, Thomas Schiano

Research output: Contribution to journalArticlepeer-review

32 Scopus citations


Background & Aims: Liver injury due to coronavirus disease 2019 (COVID-19) is being increasingly recognized. Abnormal liver chemistry tests of varying severities occur in a majority of patients. However, there is a dearth of accompanying liver histologic studies in these patients. Methods: The current report details the clinical courses of 2 patients having severe COVID-19 hepatitis. Liver biopsies were analyzed under light microscopy, portions of liver tissue were hybridized with a target probe to the severe acute respiratory syndrome coronavirus-2 S gene, and small sections from formalin-fixed paraffin-embedded liver tissue were processed for electron microscopy. Results: The liver histology of both cases showed a mixed inflammatory infiltrate with prominent bile duct damage, endotheliitis, and many apoptotic bodies. In situ hybridization and electron microscopy suggest the intrahepatic presence of severe acute respiratory syndrome coronavirus-2, the findings of which may indicate the possibility of direct cell injury. Conclusions: On the basis of the abundant apoptosis and severe cholangiocyte injury, these histopathologic changes suggest a direct cytopathic injury. Furthermore, some of the histopathologic changes may resemble acute cellular rejection occurring after liver transplantation. These 2 cases demonstrate that severe COVID-19 hepatitis can occur even in the absence of significant involvement of other organs.

Original languageEnglish
Pages (from-to)763-770
Number of pages8
JournalCellular and Molecular Gastroenterology and Hepatology
Issue number3
StatePublished - Jan 2021


  • COVID-19
  • Hepatitis
  • Liver Biopsy
  • Liver Injury
  • Non-hepatotropic Virus
  • SARS-CoV-2


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