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

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Revision as of 10:30, 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	Transaminitis (elevated AST and ALT)	Viral markers	Autoimmune markers
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	---	Percutaneous transmission is most common Higher rate of chronic progression Associated with extra hepatic manifestation such as cryoglobulinemia and membranoproliferative glomerulonephritis Fever usually present
	Hepatitis E^[5]	++	++	+/-	++	+	+++	HEV Ab	---	Fecal-oral transmission May cause fulminant disease in pregnancy Fever usually present
	CMV hepatitis^[6]	+/-	++	-	+	+	++	CMV-specific immunoglobulin (Ig)M antibody	--	Usually manifests as mononucleosis syndrome fever usually present
	EBV hepatitis^[7]	+/-	++	-	+/-	+	++	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^[8]	---	May cause both cholestatic or hepatocellular injury

References

↑ Jeong SH, Lee HS (2010). "Hepatitis A: clinical manifestations and management". Intervirology. 53 (1): 15–9. doi:10.1159/000252779. PMID 20068336.
↑ 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.
↑ 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.
↑ 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.
↑ 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.
↑ Gupta P, Suryadevara M, Das A (2014). "Cytomegalovirus-induced hepatitis in an immunocompetent patient". Am J Case Rep. 15: 447–9. doi:10.12659/AJCR.890945. PMC 4206484. PMID 25325934.
↑ Karadeniz A, Yesilbag Z, Kaya FÖ, Akgün FS (2018). "Acute hepatitis due to Epstein-Barr virus with cross-reacting antibodies to cytomegalovirus". Indian J Med Microbiol. 36 (1): 143–144. doi:10.4103/ijmm.IJMM_17_378. PMID 29735847.
↑ 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).

[pmid20068336-1] Jeong SH, Lee HS (2010). "Hepatitis A: clinical manifestations and management". Intervirology. 53 (1): 15–9. doi:10.1159/000252779. PMID 20068336.

[pmid16418523-2] 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.

[pmid29877316-3] 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.

[pmid25609256-4] 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.

[pmid24396139-5] 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.

[pmid25325934-6] Gupta P, Suryadevara M, Das A (2014). "Cytomegalovirus-induced hepatitis in an immunocompetent patient". Am J Case Rep. 15: 447–9. doi:10.12659/AJCR.890945. PMC 4206484. PMID 25325934.

[pmid29735847-7] Karadeniz A, Yesilbag Z, Kaya FÖ, Akgün FS (2018). "Acute hepatitis due to Epstein-Barr virus with cross-reacting antibodies to cytomegalovirus". Indian J Med Microbiol. 36 (1): 143–144. doi:10.4103/ijmm.IJMM_17_378. PMID 29735847.

[pmid32172228-8] 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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@@ Line 85: / Line 85: @@
 * [[Fever]] usually present
 |-
-| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Cytomegalovirus infection natural history, complications and prognosis|CMV hepatitis]]
+| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Cytomegalovirus infection natural history, complications and prognosis|CMV hepatitis]]<ref name="pmid25325934">{{cite journal| author=Gupta P, Suryadevara M, Das A| title=Cytomegalovirus-induced hepatitis in an immunocompetent patient. | journal=Am J Case Rep | year= 2014 | volume= 15 | issue=  | pages= 447-9 | pmid=25325934 | doi=10.12659/AJCR.890945 | pmc=4206484 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25325934  }} </ref>
 | style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+/-</nowiki>
 | style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>++</nowiki>
@@ Line 98: / Line 98: @@
 * [[fever]] usually present
 |-
-| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[EBV]] hepatitis
+| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[EBV]] hepatitis<ref name="pmid29735847">{{cite journal| author=Karadeniz A, Yesilbag Z, Kaya FÖ, Akgün FS| title=Acute hepatitis due to Epstein-Barr virus with cross-reacting antibodies to cytomegalovirus. | journal=Indian J Med Microbiol | year= 2018 | volume= 36 | issue= 1 | pages= 143-144 | pmid=29735847 | doi=10.4103/ijmm.IJMM_17_378 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29735847  }} </ref>
 | style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+/-</nowiki>
 | style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>++</nowiki>

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

Revision as of 10:30, 21 July 2020

Overview

Differential Diagnosis

References

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