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Severe liver failure during SARS-CoV-2 infection
  1. Sabine Weber1,
  2. Julia Mayerle1,
  3. Michael Irlbeck2,
  4. Alexander L Gerbes1
  1. 1 Department of Medicine II, University Hospital Munich, Munich, Bavaria, Germany
  2. 2 Department of Anesthesiology, University Hospital Munich, Munich, Bavaria, Germany
  1. Correspondence to Dr Sabine Weber, Department of Medicine II, University Hospital Munich, Munich 81377, Germany;{at}

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We read with interest the recently described affections of the GI system in coronavirus disease (COVID-19).1 2 In addition to the effects on the gut, mild abnormalities in liver aminotransferase levels have been observed.3 4 We here report a previously non-described severe liver failure in a patient with COVID-19.

A 65-year-old man was admitted to our emergency department with fever up to 40°C, dry cough and dyspnoea. The chest CT scan showed typical features of COVID-19, such as ground-glass opacities and peripheral consolidations. A throat swab confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Aminotransferase concentrations were slightly increased (alanine aminotransferase (ALT) 69 U/L and aspartate aminotransferase (AST) 92 U/L; upper limit of normal (ULN) ≤49 U/L). He had been receiving long-term treatment with hydrochlorothiazide and ramipril for arterial hypertension as sole medications and had no history of liver disease.

The patient was admitted to the isolation ward and was given supplementary oxygen. He received piperacillin/tazobactam and azithromycin according to hospital standards, as well as paracetamol (1 g, up to two times per day). …

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