ACUTE LIVER FAILURE ASSOCIATED WITH COVID-19 IN A 2-YEAR-OLD BOY

Almost 2 years after the first cases of the SARS-CoV-2 pandemic were reported, we are still learning about it till today. We are now more familiar with SARS-CoV-2 and its role in causing COVID-19 and that the effects of the disease is mostly a respiratory illness (1).The gastro-intestinal/hepatic systems are the next most commonly affected after the respiratory system (2). Symptoms typically include nausea, vomiting, diarrhoea and abnormal liver enzymes (2). Acute liver failure secondary to covid-19 is rare and usually occurs later in the course of the disease (2). Some studies have demonstrated that SARS-CoV or MERS caused liver injuries with elevated liver enzymes and bilirubin levels, although these changes were mild (4). Studies of COVID-19 infection have shown the incidence of liver injury to be between 14.8 to 53%, mainly presentingwith abnormal alanine transaminase/aspartate aminotransferase (ALT/AST)(4).However alkaline phosphatase remains in the normal range in both mild and severe cases. Liver injury is significantly higher in patients with severe COVID-19.The effects of COVID-19 and it sequelae in children is still not widely reported. We describe a unique case of acute liver failure in a 2 year old boy most likely due to COVID-19in Saudi Arabia.