COVID-19 due to severe acute respiratory syndrome coronavirus 2, which has become a global pandemic, produces elevated liver enzymes, especially in severe cases. The mechanism suggests involvement of an administrated drug, cytokine storm, or hypoxia, etc., as opposed to virus-induced direct damage. If liver enzymes are elevated in COVID-19, we should evaluate for the presence of other liver diseases, and strictly follow-up liver enzyme values. In patients with COVID-19 complicated by chronic liver disease, we will use telemedicine/visits by phone, so as not to interrupt the treatment of the underlying disease, avoid unnecessary outpatient visits, and strive to halt the spread of the infection. Metabolism-associated fatty liver disease, which is often related to obesity, diabetes, and hypertension, may be a risk factor for COVID-19 severity. International academic societies have recommended guidance outlining the evidence to date regarding the management of patients with COVID-19 and liver disorders, and chronic liver disease under the COVID-19 pandemic.

A 45-year-old woman with a history of hepatitis B virus (HBV) infection presented having undergone allogeneic hematopoietic stem cell transplantation for acute myeloid leukemia. Her serum ferritin level was elevated due to hemochromatosis caused by the transfusions of red blood cells. At 38 months after the transplantation, positive seroconversion of hepatitis B surface antigen and HBV-DNA was observed and the serum levels of liver injury markers and ferritin were elevated. The patient was diagnosed with HBV reactivation. Liver biopsy revealed excessive iron deposition and acute hepatitis. We initiated lamivudine treatment, which was later switched to tenofovir alafenamide. The relationship between HBV reactivation and hemochromatosis was unclear, but the serum levels of ferritin also gradually decreased with the administration of a nucleotide analog and an iron chelator. The study results suggest that, in patients with resolved HBV infection, the duration for monitoring for HBV reactivation after allogeneic bone marrow transplantation should be prolonged.

Several cases have been reported in which sorafenib was both effective for unresectable hepatocellular carcinoma (u-HCC) and psoriasis; however, other research has highlighted the exacerbation of psoriasis due to sorafenib. There are no published data regarding whether lenvatinib and ramucirumab induce the exacerbation of psoriasis in HCC patients. A 68-year-old female with u-HCC and psoriasis vulgaris started lenvatinib therapy. She had grade 3 palmar-plantar erythrodysesthesia syndrome (PPES). Furthermore, a scaly erythematous lesion developed on the right thigh and lower leg and an exacerbation of psoriasis was suspected. After stopping lenvatinib, her skin lesion significantly improved and ramucirumab was administered as a second-line therapy. She remained stable for six months without PPES or the exacerbation of psoriasis. Ramucirumab may be appropriate for u-HCC patients with psoriasis to help avoid an exacerbation of psoriasis and maintain a stable disease state.

A female patient aged 75 years old was found to be anemic upon admission during follow-up for liver cirrhosis. Detailed examinations revealed that bleeding due to gastric antral vascular ectasia (GAVE) was the cause of her anemia. The patient did not respond to repeated argon plasma coagulation (APC) procedures and continued to require intermittent blood transfusions thereafter. As such, we decided to conduct APC again after administering lusutrombopag, a thrombopoietin receptor agonist. The administration of lusutrombopag led to an increase in platelet count and, hence, hemostasis could be performed safely. Moreover, as the effect of lusutrombopag is longer than the biological half-life of platelets, we believe that it may show a hemostatic effect in GAVE patients with gastrointestinal hemorrhage.

We investigated the positive detection rates for hepatitis B surface antigens (HBsAg) and hepatitis C (HCV) antibodies as well as the elevation of AST and ALT in patients who were to undergo oral surgery. Our results revealed positive rates of 1.1% and 1.5% for HBsAgs and HCV antibodies, respectively. Patients older than 40 years had a higher proportion of positive HBsAg or HCV antibody results than did patients younger than 40 years. The rate of AST and ALT elevation was 7.3%. There were some missing data on viral infection in patient referral documents or interview sheets, suggesting a perception gap existed with respect to the seriousness of viral hepatitis among dental doctors and patients. These findings suggest that designating a hepatitis medical care coordinator might help not only in understanding patients' infection status but also in collaborating with hepatologists in the field of oral surgery.