Clinical Reports

Case Report: Clinical Features of a COVID-19 Patient With Cirrhosis


Coronavirus disease 2019 (COVID-19) was first reported in Wuhan, Hubei Province, China in December 2019. At present, COVID-19 has emerged as a global pandemic. The clinical features of this disease are not fully understood, especially the interaction of COVID-19 and preexisting comorbidities and how these together further impair the immune system. In this case study, we report a COVID-19 patient with cirrhosis. A 73-year-old woman with cirrhosis reported a fever and cough on February 6, 2020. CT of the chest indicated an infection in her bilateral lungs. She tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The woman was treated with lopinavir and ritonavir tablets and interferon alpha-2b injection, but there was no obvious effect. Although this patient was basically asymptomatic after 2 days in the hospital, the inflammation of the bilateral lungs was slow to subside as shown in CT of the chest. In addition, the white blood cell count (WBC), absolute neutrophil count, and absolute lymphocyte count remained decreased and the result of real-time reverse transcription polymerase chain reaction (PCR) (rRT-PCR) assay was still positive for SARS-CoV-2 on hospital day 28. After infusion of plasma from a recovered COVID-19 patient four times, the patient tested negative for SARS-CoV-2. She was discharged on March 13, 2020. This patient tested negative for SARS-CoV-2 after infusion of plasma from a recovered COVID-19 patient four times. Cirrhosis could impair the homeostatic role of the liver in the systemic immune response, which may affect the removal of SARS-CoV-2. This could lead to a diminished therapeutic effect of COVID-19. Thus, clinicians should pay more attention to COVID-19 patients with cirrhosis.

Introduction

At present, many studies have indicated the epidemiological and clinical characteristics of coronavirus disease 2019 (COVID-19) (1–4). However, there are many diseases that may affect the immune system, such as AIDS, cirrhosis, and advanced malignant tumors, which may affect the removal of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), further affecting the treatment of COVID-19 patients. A nationwide analysis in China analyzed the major strategies for patients with cancer in this COVID-19 crisis (5). The process of advanced cirrhosis is complicated with cirrhosis-associated immune dysfunction. Cirrhosis has the potential to injure the homeostatic role of the liver in the immune system (6, 7). In this case study, we report a case of a COVID-19 patient with cirrhosis. We describe the symptoms, diagnosis, treatment, and management of this patient, which may provide more information for the treatment of COVID-19 patients with cirrhosis.

Case Report

On February 11, 2020, a 73-year-old woman came to the Fever Clinic of the First Hospital of Changsha, China. Ten minutes later, she was taken to the examination room and evaluated by a clinic doctor. The chief complaint of the patient was a fever—her body temperature peaked at 39°C—with cough, expectoration, shortness of breath, and general weakness that started prior 5 days. She developed mild diarrhea (3–4 stools/day) 2 days prior to coming to the hospital. Her daughter was diagnosed with COVID-19. Given her symptoms and recent close contact with a COVID-19-positive patient, she decided to go to a healthcare provider. The patient had a history of cirrhosis and type 2 diabetes, but no history of smoking or drinking. Physical examination indicated a body temperature of 38.8°C, a pulse of 100 beats/min, a respiratory rate of 22 breaths/min, an oxygen saturation of 85%, and bowel sounds at four times/min. She presented with a characteristic feature of chronic liver disease, hepatic facies, and liver palms, but no spider nevus. In addition, she had thick breathing sounds on both sides of the lungs and audible wet murmurs in both the lungs. The abdomen of the patient was soft and had no lumps. No pain was found in the liver without mobile dullness.

Considering the possibility of SARS-COV-2 infection, we performed a chest CT examination and found bilateral pneumonia (Figure 1). The results of a nucleic acid amplification test (NAAT) for influenza A and B were negative. Her blood tests demonstrated simultaneous reduction of the ternary systems (red blood cells: 2.83 × 1012 cells/l; peripheral blood hemoglobin: 83 g/l; white blood cells: 0.78 × 109 cells/l; lymphocytes: 0.11 × 109 cells/l; lym%: 14.5%; platelets: 41 × 109 cells/l) and an elevated percentage of neutrophils (0.65 × 109/L; n%: 82.8%), C-reactive protein (62.5 mg/l), and erythrocyte sedimentation rate (129 mm/h) (Table 1). In view of the close contact history and clinical examination results of the patient, we carried out COVID-19 test for the patient. Specimens were collected following the Chinese Center for Disease Control and Prevention (CCDC) guidance. The results showed that she tested positive for SARS-COV-2. Therefore, she was admitted to the isolation ward for further treatment.