COVID-19 Tanılı Yoğun Bakım Hastasında Sekel Olarak Görülen Sekonder Sklerozan Kolanjit Olgusu: Olgu Sunumu
Özet
Bu vaka sunumunda, 57 yaşında bir kadın hastada şiddetli COVID-19 enfeksiyonu sonrası gelişen sekonder sklerozan kolanjit (SSC) tablosu ele alınmaktadır. Hastaneye solunum sıkıntısı ile başvuran ve COVID-19 tanısı alan hasta, durumunun kötüleşmesi üzerine yoğun bakım ünitesine (YBÜ) sevk edilerek entübe edilmiştir. YBÜ yatışının 15. gününde karaciğer enzimlerinde (ALP, GGT) ve ardından bilirubin düzeylerinde belirgin artış gözlenmiştir. Yapılan MRCP incelemesinde safra yollarında dilatasyon saptanmamasına rağmen, klinik tablo COVID-19'a bağlı safra yolları tutulumu ve SSC olarak değerlendirilmiştir. Hastada sitokin fırtınası, uzun süreli mekanik ventilasyon ve hipoksinin bu nadir sekeli tetiklediği düşünülmektedir. Sonuç olarak, COVID-19'un karaciğer ve safra yolları üzerinde kalıcı hasarlar bırakabileceği, özellikle yoğun bakımda kolestaz bulguları gösteren hastalarda SSC olasılığının göz önünde bulundurulması gerektiği vurgulanmaktadır.
This case report discusses a case of secondary sclerosing cholangitis (SSC) that developed in a 57-year-old female patient following a severe COVID-19 infection. The patient, admitted with respiratory distress and diagnosed with COVID-19, was transferred to the intensive care unit (ICU) and intubated as her condition deteriorated. On the 15th day of ICU admission, a significant increase in liver enzymes (ALP, GGT) followed by bilirubin levels was observed. Although MRCP imaging showed no dilation in the bile ducts, the clinical picture was evaluated as SSC due to bile duct involvement related to COVID-19. It is thought that the cytokine storm, prolonged mechanical ventilation, and hypoxia triggered this rare sequela. In conclusion, it is emphasized that COVID-19 can cause permanent damage to the liver and bile ducts, and the possibility of SSC should be considered in ICU patients presenting with signs of cholestasis.
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