Secondary sclerosing cholangitis after critical COVID-19: Three case reports

Table 2 Clinical characteristics

	Patient 1	Patient 2	Patient 3
Demographics
Age (yr)	45	52	46
Sex	Male	Male	Female
Comorbidities	T2D, HT, CKD KDIGO III	T2D, HT, CKD KDIGO V	T2D, HT, CKD KDIGO V
COVID-19 infection
ICU admission	Yes	Yes	Yes
Mechanical ventilation	Yes	Yes	Yes
Vasopressor support	Yes	Yes	Yes
Renal replacement therapy	Yes	Yes (on hemodialysis before admission)	Yes (on hemodialysis before admission)
Secondary infections	Ventilator-associated pneumonia due to Enterobacter cloacae, Stenotrophomonas maltophilia and Klebsiella pneumoniae	Streptococcus pneumoniae and Staphylococcus aureus bacteremia. Ventilator-associated pneumonia due to Stenotrophomonas maltophilia, Enterobacter cloacae and Aspergillus fumigatus	Ventilator associated pneumonia due to Pseudomonas aeruginosa
Antibiotics	Meropenem, vancomycin, ceftriaxone and co-trimoxazole	Meropenem, vancomycin, moxifloxacin, co-trimoxazole and voriconazole	Imipenem, piperacillin/tazobactam and moxifloxacin
COVID-19 specific therapy	Dexamethasone	Dexamethasone	Dexamethasone
Liver chemistries on admission
TB (mg/dL)	0.36	0.37	0.47
ALT (U/L)	37	20	11.8
AST (U/L)	33	46	35.9
ALP (U/L)	89	128	91
Peak liver chemistries
TB (mg/dL)	11.72	22.7	17.32
ALT (U/L)	63	62.7	7.9
AST (U/L)	119	184.1	46.4
ALP (U/L)	2146	2370	705
Last liver chemistries
TB (mg/dL)	6.41	8.82
ALT (U/L)	48	9.3
AST (U/L)	129	52.6
ALP (U/L)	3250	1870
Sclerosing cholangitis imaging findings (CT, ERCP, MRI)	Yes	Yes	Yes
Histology	Intracanalicular cholestasis, portal inflammation, ductular reaction and moderate portal fibrosis	None	None
Evidence of liver fibrosis	Yes (histology)	Yes (VCTE)	No
Death	No	No	Yes

ALP: Alkaline phosphatase; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; COVID-19: Coronavirus disease 2019; CKD: Chronic kidney disease; CT: Computed tomography; ERCP: Endoscopic retrograde cholangiopancreatography; HT: Hypertension; ICU: Intensive care unit; MRI: Magnetic resonance imaging; TB: Total bilirubin; T2D: Type 2 diabetes; VCTE: Vibration-controlled transient elastography.