Acute liver failure in a patient with recent coronavirus disease 2019 infection requiring liver transplantation: a case report.

backgroundAcute or fulminant liver failure is a rare, life-threatening disease that may be caused by various factors such as certain drugs and toxin exposure, viral infections, and hereditary syndromes. Treatment should start as soon as the disease is recognized to avoid the devastating sequelae of acute liver failure, including multiorgan failure and death. Management of acute liver failure is directed toward treating the underlying cause. Nonresponsive cases may need urgent liver transplantation. A few case reports have recently documented acute liver failure post-coronavirus disease 2019 infection. We report a unique case of acute liver failure post-coronavirus disease 2019 infection requiring urgent liver transplantation. CASE PRESENTATION: A 15-year-old, Arabic, Middle Eastern, previously healthy female patient presented with a 10-day history of abdominal pain, nausea, and vomiting. She was diagnosed with coronavirus disease 2019 infection via polymerase chain reaction 2 weeks before her presentation, and received outpatient symptomatic management with subsequent resolution of her symptoms. Clinical and laboratory data were consistent with fulminant liver failure during hospitalization, including a class C Child-Pugh and high Model for End-Stage Liver Disease incorporating serum sodium scores. Prompt referral to a liver transplant center was pursued, and liver transplantation was performed on day 2 of her presentation, with a subsequent improvement in her condition.

conclusionWe report the case of a patient with a recent coronavirus disease 2019 infection who presented with otherwise unexplained fulminant liver failure requiring urgent liver transplantation. Acute hepatitis and liver failure may occur secondary to coronavirus disease 2019 infection and require prompt recognition and management, including urgent liver transplantation for some patients with fulminant liver failure.