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Coronavirus Disease 2019 in Autoimmune Hepatitis: A Lesson From Immunosuppressed
Patients
#MMPMID32838102
Gerussi A
; Rigamonti C
; Elia C
; Cazzagon N
; Floreani A
; Pozzi R
; Pozzoni P
; Claar E
; Pasulo L
; Fagiuoli S
; Cristoferi L
; Carbone M
; Invernizzi P
Hepatol Commun
2020[Sep]; 4
(9
): 1257-1262
PMID32838102
show ga
Chronic immunosuppression is associated with increased and more severe viral
infections. However, little is known about the association between
immunosuppression and severe acute respiratory syndrome coronavirus 2
(SARS-CoV-2) infection. Our aim was to describe the clinical course of patients
with immunosuppressed autoimmune hepatitis (AIH) during coronavirus disease 2019
(COVID-19) infection in Italy. Our study is a case series of patients with AIH
treated with immunosuppression, who tested positive for SARS-CoV-2 in March 2020
during the outbreak of COVID-19. Ten patients from seven different hospitals in
Italy were diagnosed with COVID-19 during the outbreak of SARS-CoV-2 in March
2020. Seven subjects were female (70%), and age ranged from 27 to 73 years.
Before the onset of SARS-CoV-2 infection, all patients were taking
immunosuppressive therapy for AIH, and eight of them were on biochemical
remission. Two other patients had recent acute onset of their AIH, and
consequently started high-dose steroids, as per induction protocol. All patients
had a respiratory syndrome and a positive nasal swab for SARS-CoV-2. Five
patients developed a computed tomography-confirmed COVID-19 pneumonia. Six
subjects received a combination of antiretroviral and antimalarial drugs. In
seven patients, the dosage of immunosuppressive medication was changed. Liver
enzymes were repeated during SARS-CoV-2 infection in all hospitalized cases; they
remained within the normal range in all cases, and improved in the two acute
cases treated with high-dose steroids. The clinical outcome was comparable to the
reported cases occurring in non-immunosuppressed subjects. Conclusion: Patients
under immunosuppressive therapy for AIH developing COVID-19 show a disease course
presumptively similar to that reported in the non-immunosuppressed population.
These data might aid in medical decisions when dealing with SARS-CoV-2 infection
in immunocompromised patients.
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