Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, has led to a global health crisis. The virus can cause varying severity of liver injury, but the mechanism has not yet been elucidated, especially in pregnancy.

We present a morbidly obese 30-year-old woman with COVID-19 at 28 weeks' gestation complicated by significant transaminitis with peak liver enzymes levels of 501/1,313 (aspartate aminotransferase/alanine aminotransferase). Liver biopsy showed reactive changes consistent with medication effect and mild steatosis.

Significant transaminitis has been found in both pregnant and nonpregnant patients with COVID-19. Our case demonstrates the multifactorial nature of liver injury in COVID-19 patients including mild underlying liver steatosis combined with possible viral potentiation of medication effect.

Received: 23 November 2020

Accepted: 30 August 2023

Article published online:
28 November 2023

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