Secondary Sclerosing Cholangitis of the Critically Ill Patient suffering from COVID19

Secondary sclerosing cholangitis of the critically ill patient (SSC-CIP) has been reported for patients requiring intensive care treatment (ICT). It is hypothesized that mechanical ventilation and high-dose vasopressor treatment foster formation of biliary casts through ischemia and necrosis of the biliary endothelium. The disease is characterized by rapid progression, poor prognosis, and limited therapeutic options. Emerging numbers of patients, requiring ICT due to the SARS-COV-2 pandemic, have resulted in several case series reports describing SSC-CIP in these patients.

This case report summarizes the clinical course of a 66-year-old patient, wo had received ICU treatment for SARS-COV-2 in a peripheral county hospital in Austria. On the twelfth day following admission the patient presented with rising transaminases and cholestasis. Initial suspicion of drug induced liver injury was attributed to multiple antibiotic regimens for bacterial superinfection and suspicion of abdominal abscessing. The diagnosis was revoked when discontinuation of treatment did not result in improvement. Magnetic resonance cholangiopancreatography showed features of cholangitis. The patient was subsequently transferred to our gastroenterology department at the University Clinic of St. Pölten to undergo repeated endoscopic retrograde cholagiopancreaticographies for removal of biliary casts. The patient received nutritional support and physiotherapy rehabilitation. However, the patient’s state did not improve. Though liver transplantation was initially considered, severe progressing sarcopenia ultimately posted a contraindication, resulting in fatal outcome.

SSC-CIP could be a distinct disease entity related to SARS-COV-2. Limited therapeutic options and ICU acquired asthenia is associated with increased mortality. Liver transplantation is often the only potentially beneficial treatment option. Frailty and sarcopenia are relevant prognostic factors for patients undergoing LT. Early targeted physiotherapeutic and nutritional measures in ICU setting may reduce mortality rate due to sarcopenia. Prevention through vaccination may ultimately reduce ICU admissions, necessity of LT and mortality. Key Words: COVID19, Secondary Sclerosing Cholangitis of the critically ill

Publication History

Article published online:
01 September 2021