Algerian doctors report blood-pooling in liver of otherwise healthy COVID-19 patient

In a recent case in Algeria, doctors examined a woman who was experiencing pain and fever related to blood-pooling, also called hematoma, in her liver. Scans revealed that the woman had no signs of liver injury, but did have Covid-19, which the doctors believe could have been related to the bleeding.

Typically, liver hematoma may be caused by damage to the liver tissues or by tumours, but doctors couldn’t find any evidence of such issues. They also drained the blood from the hematoma and checked to see if the woman was suffering from a bacterial infection, but results for those tests also came back negative.

It was only when they noticed an abnormality on a CT-scan, which included the patient’s chest and lungs, that they began to suspect a Covid-19 infection. A reverse transcription-polymerase chain reaction (RT-PCR) test confirmed that she was Covid-19-positive.

Once the doctors knew she was infected with the SARS-CoV-2 virus, they were able to quickly treat her. They brought down her fever and sent her home after a week in hospital.

This case study adds to our knowledge of how Covid-19 infection can develop in the body. In the past, scientists have seen issues of hematoma and haemorrhaging (bleeding) in other organs, such as the heart, and in glands connected to the kidneys. This is the first time, however, that a potential link between Covid-19 and bleeding in the liver has been made.

It is important to track potential Covid-19 complications involving bleeding, especially because another common symptom of severe Covid-19 is blood-clotting. Doctors sometimes give patients anti-clotting drugs as a precaution against blood-clotting, but this treatment would worsen bleeding in patients with hematoma.

The doctors note, however, that the link between Covid-19 and liver hematoma is still uncertain, and that it isn’t possible at this early stage to definitively attribute the cause of this woman’s liver bleed to Covid-19.

Abstract

Hemorrhagic manifestations during COVID-19 infections are increasingly described in the literature. We report the first case of spontaneous subcapsular hematoma of the liver revealing a COVID-19 infection in a 44-year-old woman with no underlying health condition history, a computerized tomography evaluation showed an aspect of lung ground-glass opacities, with moderate impairment estimated at about 20%. Reverse transcription-polymerase chain reaction confirmed the diagnosis of COVID-19 infection. During the COVID-19 pandemic, non-traumatic bleeding such as spontaneous hematomas in patients with no coagulation disorder could be a manifestation of COVID-19 infection.

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