Pinky Bai, MD, Srilekha Bathi, MD, Lakshmi Chirumamilla, MD, Ali Chand, MD, Mukarram Jamat Ali, MD, Sneha Adidam, MD, Angesom Kibreab, MD Howard University Hospital, Washington, DC Introduction: Intrahepatic cholestasis of pregnancy (ICP) is a gestation specific liver disorder and presents during third trimester of pregnancy. Very rarely an ICP can occur early in pregnancy and usually associated with IVF pregnancies.
Case Description/
Methods: Patient was a 39-year-old gravida 3 para 2 (G3P2) woman with no significant past medical history who was referred to our tertiary care centre by her Obstetrician at 8 weeks' gestation for deranged liver associated enzymes (LAEs) in the setting of pregnancy. Two weeks prior this presentation, she was seen by her primary care physician for fever, generalized weakness, vomiting, and diarrhoea and found to be positive for SARS-CoV-2. She was managed symptomatically with acetaminophen. Ten days later, she presented to her Obstetrician for nausea, vomiting, jaundice, icterus and pruritus. Laboratory results showed elevated LAEs, INR 1.3 and bile acid 522μmol/L. Upon admission, vitals unremarkable and physical exam was notable for generalized jaundice, scleral icterus and erythematous rash of chest and back with sparing of palms and soles. Investigations were significant for AST 895 IU/L, ALT 697 IU/L, ALP 288 IU/L, T.Bili 10.8 mg/dl, D.Bili 6.7 mg/dl. INR 1.13 and Bile acid 138.8 μmol/L. Additionally, Viral etiology for HBsAg, HCV, HAV, HEV, HIV, CMV, EBV, HSV 1, HSV 2 were negative. Toxoplasma gondii and Immunological analysis (ANA and AMA) were negative too. Ceruloplasmin and IgG were within the reference values. SARS-CoV-2 negative. Serum Acetaminophen level was < 0.2. Abdominal ultrasound demonstrate normal sized liver with increased echogenicity. No visible gallstones and no biliary distension reported. Patient’s symptoms eventually improved and LAEs continued to downtrend without any pharmacological intervention (Ursodeoxycholine acid). She was discharged home with outpatient follow up with Obstetrician. Two months later, repeat hepatic panel was within normal limit. Patient had induction of labour with spontaneous vaginal delivery at 37 weeks of gestation due to preeclampsia. Improvement in BA mirrored resolution of COVID symptoms without any pharmacological intervention. Thus, patient’ presentation was thought to be secondary to COVID-19 associated hepatic impairment. Discussion: BA can also be elevated in COVID-19 due to hepatocyte injury in a similar manner as seen in acute viral hepatitis. Physicians should be cognizant of the association of hepatic cholestasis and COVID-19 while evaluating the pregnant patients who present with elevated BA.
Disclosures: Pinky Bai indicated no relevant financial relationships. Srilekha Bathi indicated no relevant financial relationships. Lakshmi Chirumamilla indicated no relevant financial relationships. Ali Chand indicated no relevant financial relationships. Mukarram Jamat Ali indicated no relevant financial relationships. Sneha Adidam indicated no relevant financial relationships. Angesom Kibreab indicated no relevant financial relationships.
Pinky Bai, MD, Srilekha Bathi, MD, Lakshmi Chirumamilla, MD, Ali Chand, MD, Mukarram Jamat Ali, MD, Sneha Adidam, MD, Angesom Kibreab, MD. P0183 - Challenging the Diagnosis of ICP: A Pregnant Patient With Transient Cholestasis and COVID-19 Exposure, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
