Journal Article

COVID-19 infection in first trimester of pregnancy marked by a liver cytolysis in a woman previously treated by hydroxychloroquine for repeated implantation failure: a case report

P. Calès, A. Guerin, L. Delaroche, V. Place, P. Descamps, R. Dieli-crimi, F. Lamazou, V. Letouzey, S. Octernaud, P. Oger

2020

Overview

Background In December 2019, a new disease (COVID-19) caused by a novel coronavirus called SARS-CoV-2 emerged in China and spread to many other countries. There is only limited data about the clinical features of COVID-19 during pregnancy, especially in first trimester. Case presentation We report a COVID-19 infection in a 35 years-old patient in first trimester of pregnancy and its consequent medical care. At 7 weeks of pregnancy, the patient, who did not have any pregestational comorbidities, complained of intense nausea and asthenia. An important liver cytolysis was discovered with biological perturbations of transaminases levels. No respiratory symptoms were recorded. Classical viral aetiologies and drug-related toxicity were discarded. Because of the aggravation of the symptoms and the occurrence of the breathlessness, the patient was tested for the COVID-19 in a nasopharyngeal swab. The RTq-PCR assay indicated the presence of SARS-CoV-2 RNA. In the absence of severe symptoms, the patient was monitored at home according to the French government guidelines. After a few days, the symptoms resolved without any complications. The pregnancy is still ongoing without any visible sequelae on the foetus so far. Conclusions This first case illustrated the difficulty of COVID-19 diagnosis in patients with isolated digestive symptoms in first trimester of pregnancy that could be confused with gravida hyperemesis. Monitoring of pregnancy after an episode of COVID-19 should be strengthened with bimonthly foetal growth ultrasounds and doppler assessments because of the risks for intrauterine growth restriction. Comprehensive data on larger numbers of first trimester gravid women with COVID-19 are required to better understanding the overall impact of SARS-CoV-2 on maternal and birth outcomes.

• Publisher: Springer Science and Business Media LLC,BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics / [SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology / [SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases / [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases / [SDV.SP.MED]Life Sciences [q-bio]/Pharmaceutical sciences/Medication / Adult / Amenorrhea / Antiviral Agents / Antiviral Agents - pharmacology / Antiviral Agents - therapeutic use / Asthenia / Betacoronavirus / Betacoronavirus - genetics / Betacoronavirus - isolation & purification / Blood tests / Care and treatment / Case Report / Case reports / Childbirth & labor / China / Complications / Coronavirus Infections / Coronavirus Infections - pathology / Coronaviruses / COVID-19 / Cytolysis / Cytomegalovirus / Demographic aspects / Diabetes / Diagnosis / Diagnosis, Differential / Disease transmission / Embryo Implantation / Embryo Implantation - drug effects / Emerging diseases / Enzymes / Female / Fetuses / First trimester / Gynecology and obstetrics / Hepatic cytolysis / Hepatitis / Human health and pathology / Humans / Hydroxychloroquine / Hydroxychloroquine - pharmacology / Hydroxychloroquine - therapeutic use / Hépatology and Gastroenterology / Immunomodulators / Implantation / Infections / Infectious and parasitic diseases / Infectious Diseases / Internal Medicine / Life Sciences / Liver / Liver - enzymology / Liver - pathology / Medical Microbiology / Medication / Medicine / Medicine & Public Health / MESH: Antiviral Agents / therapeutic use / MESH: Betacoronavirus / genetics / MESH: Betacoronavirus / isolation & purification / MESH: Coronavirus Infections / pathology / MESH: Hydroxychloroquine / therapeutic use / MESH: Liver / pathology / MESH: Pneumonia, Viral / pathology / MESH: Pregnancy Complications, Infectious / pathology / MESH: Transaminases / metabolism / Miscarriage / Morphology / Mortality / Nausea / Pandemics / Parasitology / Patients / Pharmaceutical sciences / Pneumonia, Viral / Pneumonia, Viral - pathology / Pregnancy / Pregnancy complications / Pregnancy Complications, Infectious / Pregnancy Complications, Infectious - pathology / Pregnancy Trimester, First / Premature labor / RC109-216 / Real-Time Polymerase Chain Reaction / Ribonucleic acid / Risk factors / RNA / RNA, Viral / RNA, Viral - isolation & purification / SARS-CoV-2 / Severe acute respiratory syndrome coronavirus 2 / Signs and symptoms / Toxicity / Transaminases / Transaminases - metabolism / Tropical Medicine / Ultrasonic imaging / Viral diseases / Viral infections / Womens health