COVID-19-associated hepatic injury differential diagnosis: Difference between revisions

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| rowspan="6" style="background:#4479BA; color: #FFFFFF" |Acute viral hepatitis
| rowspan="6" style="background:#4479BA; color: #FFFFFF" |Acute viral hepatitis
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Hepatitis A]]
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Hepatitis A]]<ref name="pmid20068336">{{cite journal| author=Jeong SH, Lee HS| title=Hepatitis A: clinical manifestations and management. | journal=Intervirology | year= 2010 | volume= 53 | issue= 1 | pages= 15-9 | pmid=20068336 | doi=10.1159/000252779 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20068336  }} </ref><ref name="pmid16418523">{{cite journal| author=Nainan OV, Xia G, Vaughan G, Margolis HS| title=Diagnosis of hepatitis a virus infection: a molecular approach. | journal=Clin Microbiol Rev | year= 2006 | volume= 19 | issue= 1 | pages= 63-79 | pmid=16418523 | doi=10.1128/CMR.19.1.63-79.2006 | pmc=1360271 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16418523  }} </ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +++
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +++
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ++
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ++
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* [[Fever]] usually present
* [[Fever]] usually present
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| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Hepatitis B]]
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Hepatitis B]]<ref name="pmid29877316">{{cite journal| author=Yuen MF, Chen DS, Dusheiko GM, Janssen HLA, Lau DTY, Locarnini SA | display-authors=etal| title=Hepatitis B virus infection. | journal=Nat Rev Dis Primers | year= 2018 | volume= 4 | issue=  | pages= 18035 | pmid=29877316 | doi=10.1038/nrdp.2018.35 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29877316  }} </ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +++
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +++
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ++
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ++
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* [[Fever]] usually present
* [[Fever]] usually present
|-
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| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Hepatitis C]]
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Hepatitis C]]<ref name="pmid25609256">{{cite journal| author=Mukherjee R, Burns A, Rodden D, Chang F, Chaum M, Garcia N | display-authors=etal| title=Diagnosis and Management of Hepatitis C Virus Infection. | journal=J Lab Autom | year= 2015 | volume= 20 | issue= 5 | pages= 519-38 | pmid=25609256 | doi=10.1177/2211068214563794 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25609256  }} </ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +++
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +++
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>++</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>++</nowiki>
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* [[Fever]] usually present
* [[Fever]] usually present
|-
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| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Hepatitis E]]
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Hepatitis E]]<ref name="pmid24396139">{{cite journal| author=Kamar N, Dalton HR, Abravanel F, Izopet J| title=Hepatitis E virus infection. | journal=Clin Microbiol Rev | year= 2014 | volume= 27 | issue= 1 | pages= 116-38 | pmid=24396139 | doi=10.1128/CMR.00057-13 | pmc=3910910 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24396139  }} </ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>++</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>++</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>++</nowiki>
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* May cause both cholestatic or hepatocellular injury
* May cause both cholestatic or hepatocellular injury
|}
|}


== References ==
== References ==
{{reflist|2}}
{{reflist|2}}

Revision as of 10:21, 21 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Tayyaba Ali, M.D.[2]

Overview

COVID-19-associated hepatic Injury must be differentiated from other conditions that cause elevation of liver enzymes.

Differential Diagnosis

COVID-19-associated hepatic Injury must be differentiated from other conditions that cause elevation of liver enzymes.

Disease Clinical manifestations Laboratory findings Additional findings
Symptoms Signs Transaminitis (elevated AST and ALT) Viral markers Autoimmune markers
Nausea & vomiting Abdominal pain Arthralgia Jaundice Hepatomegaly
Acute viral hepatitis Hepatitis A[1][2] +++ ++ + +++ + +++ HAV Ab ---
  • Fecal-oral transmission
  • Usually acute and self limit
  • Fever usually present
Hepatitis B[3] +++ ++ ++ +++ + +++ HBs Ag, HBc Ab, HBe Ag ---
  • Percutaneous transmission most common
  • May cause acute hepatic failure or may become chronic
  • Fever usually present
Hepatitis C[4] +++ ++ ++ +++ + +++ HCV Ab ---
Hepatitis E[5] ++ ++ +/- ++ + +++ HEV Ab ---
  • Fecal-oral transmission
  • May cause fulminant disease in pregnancy
  • Fever usually present
CMV hepatitis +/- ++ - + + ++ CMV-specific immunoglobulin (Ig)M antibody --
  • Usually manifests as mononucleosis syndrome
  • fever usually present
EBV hepatitis +/- ++ - +/- + ++ Heterophile antibody test, monospot test --
  • Systemic manifestations as mononucleosis syndrome
  • Fever usually present
Autoimmune hepatitis - + +/- ++ + +++ --- ANA, ASMA, anti SLA/LP, ANCA, ALKM-1 antibodies
  • Liver biopsy may be required for diagnosis
Alcoholic hepatitis +/- + - + - AST>ALT --- ---
  • History of alcohol intake
Drug induced hepatitis +/- + - + + ++ --- ---
  • May cause either cholestatic or hepatocellular injury
COVID-19-associated hepatic Injury + + - - + ++ IgG/IgM Antibodies[6] ---
  • May cause both cholestatic or hepatocellular injury

References

  1. ↑ Jeong SH, Lee HS (2010). "Hepatitis A: clinical manifestations and management". Intervirology. 53 (1): 15–9. doi:10.1159/000252779. PMID 20068336.
  2. ↑ Nainan OV, Xia G, Vaughan G, Margolis HS (2006). "Diagnosis of hepatitis a virus infection: a molecular approach". Clin Microbiol Rev. 19 (1): 63–79. doi:10.1128/CMR.19.1.63-79.2006. PMC 1360271. PMID 16418523.
  3. ↑ Yuen MF, Chen DS, Dusheiko GM, Janssen HLA, Lau DTY, Locarnini SA; et al. (2018). "Hepatitis B virus infection". Nat Rev Dis Primers. 4: 18035. doi:10.1038/nrdp.2018.35. PMID 29877316.
  4. ↑ Mukherjee R, Burns A, Rodden D, Chang F, Chaum M, Garcia N; et al. (2015). "Diagnosis and Management of Hepatitis C Virus Infection". J Lab Autom. 20 (5): 519–38. doi:10.1177/2211068214563794. PMID 25609256.
  5. ↑ Kamar N, Dalton HR, Abravanel F, Izopet J (2014). "Hepatitis E virus infection". Clin Microbiol Rev. 27 (1): 116–38. doi:10.1128/CMR.00057-13. PMC 3910910. PMID 24396139.
  6. ↑ Lippi G, Simundic AM, Plebani M (2020). "Potential preanalytical and analytical vulnerabilities in the laboratory diagnosis of coronavirus disease 2019 (COVID-19)". Clin Chem Lab Med. 58 (7): 1070–1076. doi:10.1515/cclm-2020-0285. PMID 32172228 Check |pmid= value (help).
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