S2651 Acute Liver Infarct with a Superimposed Liver Abscess as a Consequence of Hypercoagulable State in a Patient with COVID-19 Without Respiratory Manifestations

Abstract

Introduction: COVID-19 infection have been associated to a hypercoagulable state. We present a case of a 66-year-old man with SARS-CoV-2 infection without respiratory symptoms that debuted with thrombosis of the portal vein and branches of the hepatic artery, liver infarction and superimposed hepatic abscess as the only clinical manifestation. Hepatocellular carcinoma, liver cirrhosis, intra-abdominal and pelvic inflammation or infection were absent. No history of coagulopathies reported. We postulate that the hypercoagulable state associated to COVID-19 led to thrombosis of the portal vein and branches of the hepatic artery leading to patient's clinical presentation and ultimate complications. Case Description/Methods: A 66-year-old man presented to the ED complaining of fever, night sweats, generalized malaise, unintentional weight loss, and epigastric pain. Ten days prior, a COVID- 19 PCR test was done with positive results. Physical examination demonstrated bilateral clear lungs and a benign abdomen. Labs showed neutrophilic leukocytosis, reactive thrombocytosis, normocytic normochromic anemia, elevation of liver enzymes and inflammatory markers. Abdominal US revealed acute PVT. He was admitted and started on vancomycin, piperacillin/tazobactam and full anticoagulation with enoxaparin. Chest CT scan excluded pulmonary consolidations and ground glass opacities. Abdominopelvic contrast CT scan confirmed the PVT involving the main, right and left portal veins without collateral vessels. No other infectious foci was identified. Contrast MRI findings were consistent with a multiseptated liver abscess within the left liver lobe lateral segment and PVT associated with a large infarction involving the right liver lobe anterior segment and the left liver lobe medial and lateral segments. Blood and urine cultures, stool ova and parasite, E. histolytica IgG ELISA and viral hepatitis panel were negative. After 12 days, the patient was discharged to complete 4 weeks of antibiotics and 6 months of full anticoagulation. Follow-up contrast CT scan showed new cavernous transformation of the porta hepatis and resolution of the liver abscess. Discussion: Physicians should be aware that patients with COVID-19 infection can debut with thromboembolic phenomenon and potential involvement of hepatic circulation as the only clinical manifestation of COVID-19. Prompt recognition can help physicians to direct appropriate therapy earlier for these complications, which can have a significant impact in patient's outcomes and prognosis. (Table Presented).