key: cord-296767-mgr32ftl
authors: Große, Karsten; Kramer, Matthijs; Trautwein, Christian; Bruns, Tony
title: SARS‐CoV‐2 as an extrahepatic precipitator of acute‐on‐chronic liver failure
date: 2020-05-29
journal: Liver Int
DOI: 10.1111/liv.14540
sha: 
doc_id: 296767
cord_uid: mgr32ftl

We read with great interest the report by Qiu and colleages reporting the first case of acute-on-chronic liver failure (ACLF) following SARS-CoV-2 infection. Based on elevated transaminases, jaundice, and coagulopathy, the authors discuss hepatic virus entry and systemic inflammation as possible underlying mechanisms. As ACLF following hepatic versus extrahepatic insults may differ in presentation, course, and prognosis, we herein report the case of a patient with ACLF precipitated by extrahepatic complications of SARS-CoV-2.

To the Editor We read with great interest the report by Qiu et al 1 reporting the first case of acute-on-chronic liver failure (ACLF) following SARS-CoV-2 infection. Based on elevated transaminases, jaundice and coagulopathy, the authors discuss hepatic virus entry and systemic inflammation as possible underlying mechanisms. 1 As ACLF following hepatic vs extrahepatic insults may differ in presentation, course and prognosis, 2 we herein report the case of a patient with ACLF precipitated by extrahepatic complications of SARS-CoV-2.

A known 65-year-old male with non-alcoholic steatohepatitis (NASH) cirrhosis and ascites was admitted to hospital following nausea, vomiting, reduced food intake and diarrhoea for the past 2 days. The patient did not report respiratory symptoms. Initial 

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