Abstract
COVID-19, caused by SARS-CoV-2, has been declared an international public health emergency. Patients with COVID-19, even without a history of liver disease, frequently present with liver test disturbances. Due to the multisystemic involvement of COVID-19, the pathogenesis of liver injury is likely to be multifactorial, involving systemic inflammation, small vessel thrombosis, hepatic hypoxia, and potential drug toxicity, ruling out direct infection of hepatocytes by SARS-CoV-2. COVID-19 can cause severe acute hepatitis. We report the case of a 25-year-old man admitted to emergency with abdominal pain who presented with acute severe liver failure before respiratory signs.