Nosocomial COVID-19 Infection and Severe COVID-19 Pneumonia in Patients Hospitalized for Alcoholic Liver Disease: A Case Report

Wiśniewska, Hanna; Skowron, Miłosz; Bander, Dorota; Hornung, Monika; Jurczyk, Krzysztof; Karpińska, Ewa; Laurans, Łukasz; Socha, Łukasz; Czajkowski, Zenon; Wawrzynowicz-Syczewska, Marta

Case series Patient: Female, 31-year-old • Female, 40-year-old Final Diagnosis: Alcohol liver disease • COVID-19 Symptoms: Ascites • cough • dyspnea • jaundice Medication: — Clinical Procedure: CT scan Specialty: Anesthesiology • Gastroenterology and Hepatology • Infectious Diseases • General and Internal Medicine OBJECTIVE: Rare co-existance of disease or pathology BACKGROUND: COVID-19 is an infectious disease caused by SARS-CoV-2. It has spread rapidly through the world, endangering human life. The main target of COVID-19 is the lungs; however, it can involve other organs, including the liver. Patients with severe COVID-19 have an increased incidence of abnormal liver function, and patients with liver disorders are considered to be at a higher risk of severe COVID-19 infection. The mechanism of liver injury reported in 14% to 53% of COVID-19 patients is poorly recognized and several possibilities need to be considered (cytokine storm, direct viral action, hypoxia). The incidence of underlying liver comorbidities in patients with a COVID-19 infection ranges from 1% to 11%. CASE REPORTS: This is a report of 2 nosocomial COVID-19 infections and severe COVID-19 pneumonia in 2 patients who were hospitalized during treatment for alcoholic liver disease (ALD). Case 1 and case 2 were a 31-year-old woman and a 40-year-old woman, respectively, with decompensated ALD and symptoms of the COVID-19 infection. Both patients were transferred from another hospital to our hospital after confirmation of COVID-19 during their hospitalization. The course of the infection progressed rapidly in both patients with the development of multiple-organ failure and death over a short period. CONCLUSIONS: There are no clear recommendations on the management of ALD in the COVID-19 pandemic. Alcoholic hepatitis may be a risk factor for severe COVID-19 and a poor outcome. A high percentage of nosocomial COVID-19 infections are observed; therefore, special precautions should be taken to minimize the risk of COVID-19 exposure.