COVID-19 as a trigger of autoimmune hepatitis. Case report

Abstract

Over the past two years, the entire medical community has taken up the fight against the new coronavirus infection. At the initial encounter with COVID-19, it seemed that this virus mainly affects the respiratory system. Still, with long-term observation, it turned out that the consequences of this disease can be much more severe and associated with lung damage and thromboembolic complications, and be a trigger for autoimmune diseases. According to the literature, after suffering COVID-19, some patients debuted systemic lupus erythematosus, hemolytic anemia, thrombocytopenia, developed GuillainBarr syndrome, vasculitis, and multiple sclerosis, and a case of autoimmune hepatitis (AIH) was described in foreign literature. AIH is a fairly rare disease, the prevalence of which in Europe is 1618 cases per 100 thousand inhabitants, affecting mainly women. It is known that chemicals and drugs (minocycline, diclofenac, methyldopa, infliximab, etanercept), viruses (HAV, HEV, EBV, HCV, CMV), environmental factors can serve as triggers of the autoimmune process in the liver. This article presents two clinical cases of AIH that developed after suffering a new coronavirus infection, which we consider as the initial provoking factor of autoimmune inflammation. Given the rarity of AIH, the description of new triggers is of clinical interest. It may be useful for doctors of different specialties since they faced drug-induced liver damage against the background of antiviral and immunobiological therapy. In the domestic literature, there have not yet been any publications devoted to the debut of AIH in adults after coronavirus infection.

Factors affecting the severity of COVID-19 and the development of complications

“…Cases of autoimmune hepatitis following COVID-19 have been reported in recently recovered patients. High titers of anti-SARS-CoV-2 IgG antibody were observed in these cases [62].…”

“…Post-COVID-19 complications can act as triggers for autoimmune disorders. Certain conditions, such as systemic lupus erythematosus, hemolytic anemia, thrombocytopenia, Guillain-Barré syndrome, vasculitis, and multiple sclerosis, have been reported in some patients after recovering from COVID-19 [62]. Furthermore, individuals who have had COVID-19 may be diagnosed with ophthalmological pathologies, including conjunctivitis, anterior uveitis, choroiditis with retinal detachment, optic neuritis, and retinal vasculitis [97].…”

Inflammatory and Autoimmune Aspects of Multisystem Inflammatory Syndrome in Children (MIS-C): A Prospective Cohort Study

“…The microbiome also affects autoimmune diseases [ 79 ]. Since the microbiome–gut–brain axis affects immunity, autoAb production, and systemic inflammation as occurs in MIS-C, the autoAb specificities associated with autoimmune disorders may be informative for the mechanisms affecting the pathophysiology of MIS-C. COVID-19 has been reported to have some connections with autoimmunity [ 80 , 81 , 82 , 83 , 84 ]. Some of the more detrimental outcomes of MIS-C may be due to Abs to self-constituents.…”

Incorporating the Molecular Mimicry of Environmental Antigens into the Causality of Autoimmune Hepatitis

“…The apparent rarity of de novo autoimmune hepatitis after coronovirus disease 2019 (COVID-19) [ 176 – 178 ] suggests that the vaccine and its delivery system of lipid nanoparticles [ 158 , 161 ] generate a more intense immunogenic signal than community-acquired infection.…”