key: cord-0717167-0e3xyt1v
authors: Ugolotti, Maria C.; Pedrazzini, Massimo; Silini, Enrico M.; Missale, Gabriele; Silva, Mario; Franzini, Christian; Palmieri, Gerardo; Costi, Renato; Montali, Filippo; Gnappi, Elisa; Terroni, Lorenza; Colizzi, Elena; Meschi, Michele; Facchinetti, Francesco
title: Vascular liver injury mimicking an intrahepatic cholangiocarcinoma in a COVID‐19 patient
date: 2021-01-26
journal: J Med Virol
DOI: 10.1002/jmv.26803
sha: 8eb25be9f9840b5da4f9df99731ef5e960547864
doc_id: 717167
cord_uid: 0e3xyt1v

The outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, responsible for coronavirus disease 2019 (COVID-19), has rapidly reached a pandemic spreading. This article is protected by copyright. All rights reserved.

To the Editor,

The outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, responsible for coronavirus disease 2019 (COVID-19), has rapidly reached a pandemic spreading.

Contagion mainly occurs through the upper respiratory tract that is often involved in early disease, and pulmonary damage is the main cause of death. Nevertheless, SARS-CoV-2 can virtually localize in every organ, engendering site-specific damage. 1 COVID-19 complications due to the prothrombotic potential associated with SARS-CoV-2 infection go beyond deep venous thrombosis and pulmonary thromboembolisms (PTEs). 2 Additional extrapulmonary tissues, such as heart, brain, and splanchnic organs, may be affected by thromboembolic events, likely originating from large vessels or due to microcirculation damage, across a wide spectrum of clinical severity. 3 Here we report the case of a COVID-19 patient who developed PTEs, multiple floating thrombi in the aorta and splenic infarcts, as well as a large hepatic lesion, suspected for intrahepatic cholangiocarcinoma, turning out to be a sequela of portal vessel damage.

The patient, a 68-year-old man, suffered from hypertension, type II diabetes mellitus, and dyslipidemia. He was receiving atorvastatin and metformin as chronic medications. No prior thrombosis or cerebrovascular events were recorded in the past medical history.

In late March 2020, the patient was hospitalized for worsening of dyspnea and oxygen desaturation, in the context of fever and dry cough. High-resolution computer tomography (HRCT) showed lung bilateral ground-glass infiltrates, consistent with COVID-19 interstitial pneumonia ( Figure 1A Figure 1B,C) . Collaterally, an irregularly, polylobulate, hypodense lesion, with ill-defined margins, was reported at the VI hepatic segment (4 × 5 cm), highly evocative for an intrahepatic cholangiocarcinoma ( Figure 1D,E) . Moreover, the presence of multiple infarcts (hilum and upper pole) in the spleen was recorded ( Figure 1C ). Given the pulmonary embolism, low-molecularweight heparin (LMWH) posology was augmented to therapeutic dose (enoxaparin 6000 IU + 8000 IU). Liver function tests remained normal during the hospitalization. Due to the progressive clinical improvement, the patient was discharged at home on at the end of April 2020, with the indication to maintain therapy with cardio aspirin and LMWH.

In the post-hospitalization regimen 1 month after the baseline exam, the patient underwent a novel contrast-enhanced CT scan.

The aortic thrombi and the splenic ischemic foci appeared significantly reduced ( Figure 1B,C) , while the hepatic lesion was unchanged ( Figure 1D,E) . As malignancy was suspected, a contrast- 

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