Seronegative Autoimmune Hepatitis: A Rare Manifestation of COVID-19

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for pandemic in 2019, commonly causes hepatic dysfunction. Liver injury ranges from mildly elevated liver enzymes to fulminant failure. Interestingly, there are cases that suggest a relationship between autoimmune hepatitis (AIH) patients who either contracted disease 2019 (COVID-19) or were vaccinated against severe (SARS-CoV-2). We present case of 39-year-old female without significant past medical history presented with two weeks jaundice, abdominal pain, nausea, and diarrhea. She had significantly conjugated hyperbilirubinemia. also tested positive SARS-CoV-2 but denied any symptoms; her vaccination status was up date. taking hepatotoxic agents, workup negative viral hepatitis. The F-actin antibody level 22 units, serum immunoglobulin (IgG), anti-nuclear (ANA), anti-smooth muscle, anti-mitochondrial, anti-liver/kidney microsomal-1, anti-soluble antigen, anti-neutrophil cytoplasmic antibodies levels not elevated. Computerized tomography abdomen pelvis revealed hemangiomas. Eventually, biopsy performed, histology showed active lymphoplasmacytic prominent regenerative changes areas confluent necrosis. histologic findings, along patient's clinical course, suggestive patient started on systemic steroids an improvement pain as well chemical profile. discharged plans hepatology clinic follow-up. Here, we rare seronegative AIH recent COVID-19 infection discuss potential underlying mechanism. call further investigation into dysfunction COVID-19, pathophysiology behind it. Analyzing how may allow clinicians more effectively treat suffering sequelae infection, it is important exclude differential based initial workup.