Hypercoagulable state from COVID-19 in a patient with primary biliary cholangitis—a case report

: Coronavirus disease, also known as COVID-19, is an infectious disease caused by a newly discovered coronavirus. Infected individuals can manifest hepatocellular pattern of elevated liver associated tests, with cholestatic patterns being less common. Here we highlight a patient with primary biliary cholangitis (PBC) who developed worsening cholestasis and extensive liver-related thrombosis after contracting COVID-19. A case of a 48-year-old woman with underlying PBC presented with worsening cholestasis after contracting COVID-19. The results of the liver associated test at the time of her COVID-19 presentation were remarkable for increased alkaline phosphatase (AP) value 1,050 IU/L. The results of an abdominal computed tomography (CT) demonstrated a thrombosis extending from infrarenal inferior vena cava (IVC) to the suprahepatic IVC and further extending into bilateral renal veins as well as an accessory right hepatic vein. She underwent successful thrombectomy on September 2020. The results of a follow up abdominal CT in March 2021 revealed no residual IVC thrombus. However, her serum AP remained elevated at 361 IU/L at last follow-up. Our primary aim is to highlight the possible association of COVID-19 infection and the hypercoagulability leading to worsening cholestasis in a patient with underlying PBC underlying disease post-infection. This case should alert providers to consider liver-related thrombosis in the differential with patients with PBC presenting with liver associated tests.