PMC8406516_01
Longitudinal assessment of hematological and renal function. A. Total leukocytes and hemoglobin. B. Creatinine and BUN. In both panels, the line represents the locally estimated scatterplot smoothing. Relevant clinical features and interventions are shown chronologically. CT: computed tomography; IV: intravenous; BUN: blood urea nitrogen.
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In addition, the patient presented elevated troponin as well as creatinine and BUN (Fig. 1A and B). Myocarditis/Type 2 infarction were suspected, and an acute kidney injury was diagnosed (Fig. 1A and B). Patient was started on antibiotics because of suspected bacterial infection, colchicine, enoxaparin, aspirin, dexamethasone, furosemide, and intravenous fluids (Fig. 1A). Although blood cultures were negative, urine culture reported Candida spp. and nystatin was initiated (Fig. 1A). Thus, antibiotics were modified (Fig. 1A).
Longitudinal assessment of liver function. A. Transaminases and alkaline phosphatase. B. Total, direct, and indirect bilirubin. In both panels, the line represents the locally estimated scatterplot smoothing. Relevant clinical features and interventions are shown chronologically. GOT: glutamic-oxaloacetic transaminase; GPT: glutamic pyruvic transaminase; ANAs: anti-nuclear antibodies; ENAs: extractable nuclear antigens antibodies; dsDNA: anti-double stranded DNA antibodies; ANCAs: anti-neutrophil cytoplasmic antibodies; SMA: smooth muscle antibodies; AMA-M2: anti-mitochondrial antibodies type 2; LKM1: liver kidney microsome type 1 antibodies; LC1: Anti-liver cytosolic antigen type 1; SLA: soluble liver antigen antibodies; ECRP: endoscopic retrograde cholangiopancreatography.
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At the same time, the patient presented jaundice with mixed hyperbilirubinemia, elevated transaminases, and alkaline phosphatase (Fig. 2A). However, the latter was not confirmed by the cholangioresonance results, and a SARS-CoV-2 cholangiopathy was suspected (Fig. 2B). USA, and IMTEC-ANA-LIA Maxx and LIVER-LIA - Human Diagnostics Magdeburg, Germany) (Fig. 2A). Ursodeoxycholic acid and cholestyramine were prescribed to treat the mixed hyperbilirubinemia with a slight improvement in clinical manifestations.
Histology of liver biopsy. A-B. Low periportal inflammatory infiltrate without necrosis but with a severe obstructive cholestatic pattern. H&E; x 40.
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The liver biopsy exhibited a low periportal inflammatory infiltrate without necrosis but with a severe obstructive cholestatic pattern (Fig. 3).