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COVID-19 ENCEPHALITIS IN A CIRRHOTIC PATIENT

Sahar Hamza 1, Sabbah Meriam 1, Dorra Trad 1, Houssaina Jlassi 1, Norsaf Bibani 1, Dalila Gargouri 1

Affiliations

1 Habib Thameur Hospital, Tunis, Tunisia

Summary

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A 64-year-old man with hepatic sarcoidosis and cirrhosis presented with confusion as the initial manifestation of COVID-19, ultimately diagnosed with SARS-CoV-2-associated encephalitis after hepatic encephalopathy treatment failed.

The patient had Child Pugh score 8 (Class B) and MELD score 16, with confusion confirmed as COVID-19 by rapid antigen test and chest radiographs showing bilateral patchy interstitial opacities
Initial treatment for presumed hepatic encephalopathy with Lactulose and Rifaximin showed no improvement despite normal hepatoportal flow and absence of spontaneous bacterial peritonitis
Brain MRI showed hyperintensities in white matter and left insula region without granuloma, toxoplasmosis, venous thrombosis, microhemorrhages, or ischemic lesions
After neurologic evaluation concluded SARS-CoV-2-associated encephalitis, treatment with intravenous Dexamethasone resulted in full recovery without sequelae
The authors suggest that neurological manifestations in COVID-19 are not necessarily markers of critical illness and that clinicians should consider COVID-19 as a differential diagnosis in cirrhotic patients presenting with neurological symptoms

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Abstract

Clinical Case Summary

We report the case of a 64-year-old man with preexisting hepatic sarcoidosis complicated by liver cirrhosis, who presented with confusion as an initial manifestation of COVID-19 confirmed by rapid Antigenic test. His Child Pugh score was 8 (Class B) and MELD was 16. Chest radiographs showed bilateral patchy interstitial opacities. Computed tomography (CT) of the brain was normal. Lumbar puncture was not performed because of a marked thrombocytopenia. Urine cytobacteriological examination did not show a urinary tract infection. An abdominal ultrasound showed normal hepatoportal flow and a mild ascites. Ascitic fluid analysis did not show spontaneous bacterial peritonitis. Since the patient was cirrhotic, we have considered the diagnosis of hepatic encephalopathy as a possible explanation for the neurological symptoms, so he started Lactulose and Rifaximin. However, his clinical condition showed no improvement, the neurological disorders remained the same. A brain MRI showed in FLAIR MR sequences a few hyperintensities punctiform in the white matter of the supratentorial region and the subcortical of the left insula region. There were no signs of a cerebral granuloma nor toxoplasmosis. It did not show venous thrombosis. There were no microheamorragies neither ischemic lesions. After careful evaluation by neurologic experts, encephalitis associated with SARS-CoV-2 infection was concluded. The patient was treated by intravenous Dexamethasone and he fully recovered without sequelae. This case illustrates the fact that neurological manifestations associated with COVID-19 infection are not necessarily a reflection of critical illness, and should incite clinicians to actively look for any evidence of COVID-19 infection as a differential diagnosis in patients with preexisting cirrhosis, presenting with neurological symptoms, during the epidemic period of COVID-19.

Conference

UEG Week Copenhagen 2023

Submission format

Clinical Case

Session

PP 12 Clinical Cases (Posters)

Published

2023

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How to treat functional dyspepsia and gastroparesis

Jutta Keller 1, Jan Martinek 2

Affiliations

1 Israelitic Krankenhaus, Hamburg, Germany

2 Institute for Clinical and Experimental Medicine Gastroenterology & Hepatology, Praha, Czech Republic

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Abstract

Event

UEG Week Barcelona 2026

Session

Gastroparesis and functional dyspepsia

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

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PPIs: Pros and cons evidence-based data

Christian Schulz 1

Affiliations

1 Ludwig Maximilian University, Munich, Germany

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Abstract

Event

UEG Week Barcelona 2026

Topics

Stomach & H. Pylori Mechanisms & Personalised Medicine

Session

Therapy update: Acid-related disorders

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

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A new treatment paradigm – addressing fibro-inflammation in IBD (Agomab) (Complete Session)

Bruce E. Sands 1, Florian Rieder 2, Geert R. D'Haens 3

Affiliations

1 Icahn School of Medicine at Mount Sinai, New York, United States of America

2 Cleveland Clinic Foundation, Cleveland, United States of America

3 AMC Amsterdam Inflammatory Bowel Disease Centre - Academic Medical Center, AMC Amsterdam Inflammator, Amsterdam, Netherlands

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Abstract

Event

UEG Week Barcelona 2026

Session

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Citation

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From first flare to lifelong care: European recommendations on pancreatic exocrine insufficiency and beyond

Isabelle Scheers 1

Affiliations

1 Cliniques universitaires Saint-Luc, Brussels, Belgium

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Abstract

Event

UEG Week Barcelona 2026

Topics

Digestive Oncology Primary Care Pancreas

Session

From guidelines to clinical practice: Pancreas in focus – new rules, bold moves

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

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Julio Bai 1

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1 Hospital de Gastroenterología Dr. C. Bonorino Udaondo, Buenos Aires, Argentina

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Abstract

Event

UEG Week Barcelona 2026

Session

Hot topics from Pan-America

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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PREVALENCE AND INDEPENDENT PREDICTORS OF SMALL INTESTINAL BACTERIAL OVERGROWTH IN PATIENTS WITH LIVER DISEASES: A CROSS-SECTIONAL STUDY

Gülüstan Babayeva 1, Rashad Hasanov 2,1, Esmira Abdullayeva 3

Affiliations

1 Azerbaijan State Advanced Training Institute for doctors named after A.ALIYEV, Baku, Azerbaijan

2 German Hospital Baku, Baku, Azerbaijan

3 Istanbul NS Clinic, Baku, Azerbaijan

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Abstract

Introduction

The gut–liver axis has a central role in the pathophysiology of chronic liver diseases. Small intestinal bacterial overgrowth (SIBO), as a manifestation of intestinal dysbiosis, may contribute to hepatic inflammation, altered bile acid metabolism, and disease progression. However, the prevalence of SIBO across different liver disease phenotypes and its independent clinical predictors remain insufficiently defined

Aims & Methods

Aim: To determine the prevalence of SIBO in patients with liver diseases and to identify laboratory and disease-related factors independently associated with SIBO positivity.
Methods: In this cross-sectional study, consecutive patients with liver-related disorders were evaluated using a structured clinical and biochemical dataset. After data cleaning and exclusion of repeated header rows and records with unavailable SIBO status, 328 patients were included in the final analysis. Patients were stratified into SIBO-positive and SIBO-negative groups. Continuous variables were compared using non-parametric tests, while categorical variables were analyzed using chi-square testing. To identify independent predictors of SIBO, multivariable logistic regression was performed using a complete-case model including age, sex, alanine aminotransferase (ALT), alkaline phosphatase (ALP), and active/acute hepatitis C virus (HCV) status.

Results

Among 328 patients, 116 (35.4%) were SIBO-positive and 212 (64.6%) were SIBO-negative. On univariate analysis, SIBO-positive patients had significantly higher ALT [median 42.5 vs 32.0, p=0.0027], AST [33.9 vs 27.2, p=0.0115], and ALP [95.9 vs 80.8, p=0.0047] levels compared with SIBO-negative patients. No significant differences were observed for sex (p=0.173), platelet count (p=0.699), GGT (p=0.366), or FIB-4 score (p=0.967), while age showed a borderline trend (p=0.073). SIBO prevalence differed significantly across liver disease categories (p=0.0016), with the highest rate observed in active/acute HCV infection (64.3%), followed by other HCV-related disease (53.8%), whereas lower rates were found in MAFLD/NASH (31.3%), HBV (34.8%), cirrhosis (30.0%), and cured HCV (20.0%). In multivariable logistic regression, active/acute HCV emerged as a strong independent predictor of SIBO positivity (OR 7.20, 95% CI 2.92–17.74, p<0.001). Higher ALP also remained independently associated with SIBO (OR 1.04 per 10-unit increase, 95% CI 1.00–1.09, p=0.043), whereas age, sex, and ALT were not independently significant. The general distribution of patients is presented in Table 1.

Table 1. The general distribution of patients with liver diseases (SIBO(+) and SIBO(-)).

Disease Category	Total (n)	SIBO (+), n (%)	SIBO (−), n (%)
HCV active/acute	42	27 (64.3%)	15 (35.7%)
HCV (other)	13	7 (53.8%)	6 (46.2%)
HBV	66	23(34.8%)	43(65.2%)
MAFLD/NASH	144	45 (31.3%)	99 (68.7%)
Cirrhosis	10	3 (30.0%)	7 (70.0%)
HCV cured	30	6 (20.0%)	24 (80.0%)

Conclusion

SIBO is common in patients with liver diseases, affecting more than one-third of this cohort. SIBO positivity was associated with higher cholestatic and hepatocellular enzyme levels on univariate analysis, while active/acute HCV and elevated ALP remained independent predictors after adjustment. These findings support a clinically relevant interaction between intestinal dysbiosis and liver disease phenotype and suggest that patients with active HCV-related disease may represent a subgroup at particularly high risk for SIBO.

Conference

UEG Week Barcelona 2026

Topics

Hepatobiliary

Submission format

Abstract

Session

Gut–liver axis in liver disease: Microbiome, barrier dysfunction, and clinical consequences (Posters)

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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