Key result
Liver transplantation resolves refractory cholestasis and Lipoprotein X hyperlipidemia after failed medical therapy.
Why the study?
The potential association between lipoprotein X and COVID-19–induced cholangiopathy and its impact on hyperlipidemia management is not well understood.
Case Report (n=1)
This case highlights that elevated Lipoprotein X in the setting of COVID-19-induced cholangiopathy may mimic true hyperlipidemia and may be resistant to standard lipid-lowering therapies, resolving only with treatment of the underlying liver disease.
Suggests transplant for refractory Lipoprotein X hyperlipidemia in COVID cholangiopathy; hypothesis-generating and should not yet change practice.
Elevated low-density lipoprotein cholesterol (LDL-C) is a well-known culprit for atherosclerosis; however, elevated lipoprotein X (LpX), an abnormal lipoprotein as dense as LDL-C, may confound differentiation between true hyperlipidemia and cholestasis-induced hyperlipidemia. We present the case of a 34-year-old man diagnosed with COVID-19–induced cholangiopathy with LpX. Despite treatment with evolocumab and plasmapheresis, the patient had persistent cholestasis and ultimately received a liver transplant, resulting in the resolution of hyperlipidemia. This case highlights the potential association between LpX and COVID-19–induced cholangiopathy, emphasizing the need for further research to better understand the underlying mechanisms and treatment options for this complex disease.
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Patel et al. (2024) conducted a case report in COVID-19-induced cholangiopathy with elevated Lipoprotein X (n=1). Evolocumab, plasmapheresis, and liver transplant was evaluated. Liver transplantation resolved persistent cholestasis and hyperlipidemia in a 34-year-old man with COVID-19-induced cholangiopathy and Lipoprotein X who failed evolocumab and plasmapheresis.
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