Autoimmune hepatitis after COVID-19 vaccine – more than a coincidence

Abstract

The COVID-19 pandemic is still raging across the world and vaccination is expected to lead us out of this pandemic. Although the efficacy of the vaccines is beyond doubt, safety still remains a concern. We report a case of a 65-year-old woman who experienced acute severe autoimmune hepatitis two weeks after receiving the first dose of Moderna-COVID-19 vaccine. Serum immunoglobulin G was elevated and antinuclear antibody was positive (1:100, speckled pattern). Liver histology showed a marked expansion of the portal tracts, severe interface hepatitis and multiple confluent foci of lobular necrosis. She started treatment with prednisolone, with a favorable clinical and analytical evolution. Some recent reports have been suggested that COVID-19 vaccination can lead to the development of autoimmune diseases. It is speculated that the vaccine can disturb self-tolerance and trigger autoimmune responses through cross-reactivity with host cells. Therefore, healthcare providers must remain vigilant during mass COVID-19 vaccination.

COVID-19 vaccine and autoimmunity. A new case of autoimmune hepatitis and review of the literature

“…Findings in liver biopsy correlate with reports of AIH following SARS-CoV-2 vaccination. Necroinflammatory hepatitis was observed in all cases of AIH following vaccination with Moderna mRNA-1273 COVID-19 [ [24] , [25] , [26] , [27] , [28] , [29] ], Pfizer-BioNTech mRNA vaccine [ [30] , [31] , [32] , [33] ], and AstraZeneca ChAdOx1 nCoV-19 vaccine [ 8 , 34 ]. It has been suggested that portal infiltration with eosinophils correlates with drug-induced liver injury, including vaccines (i.e., Moderna mRNA-1273 and AstraZeneca ChAdOx1 nCoV-19 vaccines) [ 8 , 27 , 28 ].…”

“…It has been suggested that portal infiltration with eosinophils correlates with drug-induced liver injury, including vaccines (i.e., Moderna mRNA-1273 and AstraZeneca ChAdOx1 nCoV-19 vaccines) [ 8 , 27 , 28 ]. This could partially explain the existence of hepatitis following vaccination without positivity for liver-associated autoantibodies ( Table 1 ) [ 8 , 10 , 12 , 13 , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] ].…”

Development of Hepatitis Triggered by SARS-CoV-2 Vaccination in Patient with Cancer During Immunotherapy: A Case Report

“…In contrast to the previous cases, this patient had received the Oxford-AstraZeneca vaccine, an adenovirus-based vaccine. Chow et al [ 18 ] recently conducted a systematic search of the literature about the documented cases of AIH following COVID-19 vaccination [ 14–17 , 19–30 ]. They reported that 29 patients received mRNA vaccines and three patients received the Oxford-AstraZeneca vaccine.…”

Coronavirus Disease 2019 Vaccinations in Patients With Chronic Liver Disease and Liver Transplant Recipients: An Update

“…The AEs post-vaccination usually were mild, self-limited and non-fatal including the local AEs such as pain at injection site and systemic events such as fever, fatigue, flu-like symptoms and myalgia (75)(76)(77)(78). There have been case report and case series of acute liver injury after mRNA vaccination (114)(115)(116)(117). Shroff et al (114) reported 10 of 16 patients required hospitalization and therapy with good recovery.…”