主题：【整理】新冠后遗症 -- 菜根谭

狗狗机翻：

尽管肝酶升高在患有严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 感染的住院儿童中很常见，但小儿急性肝功能衰竭是 COVID-19 疾病的一种罕见表现。我们描述了一名 3 岁以前健康的女性，她因 2 型自身免疫性肝炎而出现急性肝功能衰竭。之前有轻微的 SARS-CoV-2 感染。病毒性肝炎检测呈阴性，患者不符合儿童多系统炎症性疾病 (MIS-C) 的诊断标准。肝活检显示急性亚大块肝细胞坏死伴有活跃的 CD3+ T 淋巴细胞浸润，没有纤维化或慢性肝病的证据。大剂量甲基强的松龙治疗导致丙氨酸氨基转移酶 (ALT)、天冬氨酸氨基转移酶 (AST)、国际标准化比率 (INR) 和氨水平快速恢复正常，并且避免了肝移植。该病例强调了 SARS-CoV-2 感染与随后发展为急性肝衰竭的自身免疫性肝病之间可能存在关联。

Abstract

Although elevated liver enzymes are common in hospitalized children with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, pediatric acute liver failure is an uncommon manifestation of COVID-19 disease. We describe the case of a 3-year-old previously healthy female who developed acute liver failure secondary to type 2 autoimmune hepatitis preceded by mild infection with SARS-CoV-2. Testing for viral hepatitis was negative, and the patient did not meet diagnostic criteria for multisystem inflammatory disease in children (MIS-C). A liver biopsy showed acute submassive hepatocyte necrosis with brisk CD3+ T lymphocyte infiltration and no evidence of fibrosis or chronic liver disease. Treatment with high-dose methylprednisolone resulted in rapid normalization of alanine aminotransferase (ALT), aspartate aminotransferase (AST), international normalized ratio (INR), and ammonia levels, and liver transplantation was avoided. This case highlights a possible association between SARS-CoV-2 infection and subsequent development of autoimmune liver disease presenting with acute liver failure.