Autoimmune Hepatitis–Primary Biliary Cholangitis Overlap Syndrome Triggered by COVID-19

Singh, Balraj; Kaur, Parminder; Maroules, Michael

doi:10.12890/2021_002264

Cited by 20 publications

(17 citation statements)

References 5 publications

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“…It was a 57-year-old male with positive AMA, ASMA, and Anti-dsDNA. 24 As in our case, high serum levels of gamma-glutamyl transferase and ferritin were found. In contrast, our patient had normal gamma-globulin, with higher serum levels of total and direct bilirubin.…”

Section: Discussionsupporting

confidence: 66%

Autoimmune hepatitis and primary biliary cholangitis overlap syndrome after COVID-19

et al. 2023

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COVID-19 is commonly associated with high serum levels of pro-inflammatory cytokines, and the post-infection status can disturb self-tolerance and trigger autoimmune responses. We are reporting a 45-year-old male who was admitted with fatigue, jaundice, elevated liver enzymes (with cholestatic pattern), and acute kidney injury two weeks after recovering from a mild SARS-CoV-2 infection. Serologies for viral hepatitis and anti-mitochondrial antibody were negative, while anti-nuclear and anti-smooth muscle antibodies were positive. There were no signs of chronic liver disease, and a magnetic resonance cholangiography showed no dilatation of biliary ducts. Histologic evaluation of the liver evidenced numerous foci of lobular necrosis without ductopenia or portal biliary reaction. Considering the autoantibody profile and histologic changes, the medical team started oral prednisone, but there was a suboptimal biochemical response in the outpatient follow-up. Two months later, a second liver biopsy was performed and revealed non-suppurative destructive chronic cholangitis, extensive areas of confluent necrosis with hepatocytes regenerating into pseudorosettes, and numerous plasma cells. According to the Paris Criteria, the patient was then diagnosed with an autoimmune hepatitis-primary biliary cholangitis overlap syndrome (AIH-PBC-OS). After adding azathioprine and ursodeoxycholic acid to the treatment, there was a satisfactory response. This is the second worldwide report of an AIH-PBC-OS triggered by COVID-19, but the first case with a negative anti-mitochondrial antibody. In this setting, histologic evaluation of the liver by an experienced pathologist is a hallmark of achieving the diagnosis and correctly treat the patient.

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Section: Discussionsupporting

confidence: 66%

Autoimmune hepatitis and primary biliary cholangitis overlap syndrome after COVID-19

et al. 2023

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“…Numerous case reports on COVID‐19 with rheumatic manifestations, including autoimmune cytopenia, encephalitis, vasculitis, liver injury, arthritis, Guillain‐Barre syndrome, and so forth, have been reported 9,24–27 . In addition, protective responses produced by vaccination suggested sequential activations of various immune‐related factors and immune cells.…”

Section: Discussionmentioning

confidence: 99%

“…PBC is an autoimmune chronic liver rheumatic disease with positive serological anti‐mitochondrial antibodies (AMA) 32 . Several case reports showed female patients had elevated liver enzymes with positive AMA after COVID‐19 infection, and were diagnosed with the onset of PBC triggered by SARS‐CoV‐2 26,33 . The liver is considered the second viral target organ following the lungs 34 .…”

Section: Discussionmentioning

confidence: 99%

“…Numerous case reports on COVID-19 with rheumatic manifestations, including autoimmune cytopenia, encephalitis, vasculitis, liver injury, arthritis, Guillain-Barre syndrome, and so forth, have been reported. 9,[24][25][26][27] In addition, protective responses produced by vaccination suggested sequential activations of various immune-related factors and immune cells. Adverse events after vaccination raised concerns that fighting against COVID-19 could influence the human immune system in some uncontrollable ways.…”

Section: Discussionmentioning

confidence: 99%

“…32 Several case reports showed female patients had elevated liver enzymes with positive AMA after COVID-19 infection, and were diagnosed with the onset of PBC triggered by SARS-CoV-2. 26,33 The liver is considered the second viral target organ following the lungs. 34 injuries were progressive during COVID-19 infection, leading to a mortality rate of 43%.…”

Section: Discussionmentioning

confidence: 99%

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Genetic predisposition between coronavirus disease 2019 and rheumatic diseases: A 2‐sample Mendelian randomization study

et al. 2023

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Objective:The causalities between the coronavirus disease 2019 (COVID-19) and the risk of rheumatic diseases remain unclear. The purpose of this study was to investigate the causal effect of COVID-19 on rheumatic disease occurrence. Methods: Single nucleotide polymorphisms (SNPs), acquired from published genomewide association studies, were used to perform 2-sample Mendelian randomization (MR) on cases diagnosed with COVID-19 (n = 13 464), rheumatic diseases (n = 444 199), juvenile idiopathic arthritis (JIA, n = 15 872), gout (n = 69 374), systemic lupus erythematosus (SLE, n = 3094), ankylosing spondylitis (n = 75 130), primary biliary cholangitis (PBC, n = 11 375) and primary Sjögren's syndrome (n = 95 046). Three MR methods were used in the analysis based on different heterogeneity and pleiotropy using the Bonferroni correction. Results:The results revealed a causality between COVID-19 and rheumatic diseases with an odds ratio (OR) of 1.010 (95% confidence interval [CI], 1.006-1.013; P = .014).In addition, we observed that COVID-19 was causally associated with an increased risk of JIA (OR 1.517; 95%CI, 1.144-2.011; P = .004), PBC (OR 1.370; 95%CI, 1.149-1.635; P = .005), but a decreased risk of SLE (OR 0.732; 95%CI, 0.590-0.908; P = .004). Using MR, 8 SNPs were identified to associate with COVID-19 and recognized as significant variables. None of them were previously reported in any other diseases.Conclusions: This is the first study to use MR to explore the impact of COVID-19 on rheumatic diseases. From a genetic perspective, we found that COVID-19 could increase the risk of rheumatic diseases, such as PBC and JIA, but decrease that of SLE, thereby suggesting a potential surge in the disease burden of PBC and JIA following the COVID-19 pandemic.

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A Molecular Biomarker-Based Triage Approach for Targeted Treatment of Post-COVID-19 Syndrome Patients with Persistent Neurological or Neuropsychiatric Symptoms

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Neyazi

Braun-Dullaeus

et al. 2023

Advances in Experimental Medicine and Biology

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Autoimmune Hepatitis–Primary Biliary Cholangitis Overlap Syndrome Triggered by COVID-19

Cited by 20 publications

References 5 publications

Autoimmune hepatitis and primary biliary cholangitis overlap syndrome after COVID-19

Autoimmune hepatitis and primary biliary cholangitis overlap syndrome after COVID-19

Genetic predisposition between coronavirus disease 2019 and rheumatic diseases: A 2‐sample Mendelian randomization study

A Molecular Biomarker-Based Triage Approach for Targeted Treatment of Post-COVID-19 Syndrome Patients with Persistent Neurological or Neuropsychiatric Symptoms

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