Hepatitis A vaccine associated with autoimmune hepatitis

Abstract

To describe a case of probable relapsing autoimmune hepatitis associated with vaccination against hepatitis A virus (HAV). A case report and review of literature were written concerning autoimmune hepatitis in association with hepatitis A and other hepatotropic viruses. Soon after the administration of formalin-inactivated hepatitis A vaccine, a man who had recently recovered from an uncharacterized but self-limiting hepatitic illness, experienced a severe deterioration (AST 1687 U/L, INR 1.4). Anti-nuclear antibodies were detectable, and liver biopsy was compatible with autoimmune hepatitis. The observation supports the role of HAV as a trigger of autoimmune hepatitis. Studies in helper T-cell activity and antibody expression against hepatic proteins in the context of hepatitis A infection are summarized, and the concept of molecular mimicry with regard to other forms of viral hepatitis and autoimmunity is briefly explored.

Clinical features of antinuclear antibodies‐negative type 1 autoimmune hepatitis

“…In contrast, the exclusion of drug‐induced liver injury based on laboratory and histological examinations may be difficult. Furthermore, several drugs (infliximab, minocycline, atorvastatin, hepatitis A vaccine) have been reported to be triggers for AIH 17–20 . It is affirmed that the recent use of known hepatotoxic drugs should not be excluded 3 .…”

British Society of Gastroenterology (BSG) guidelines for management of autoimmune hepatitis

“…Several cases of AIH have been associated with minocycline,27–31 interferon α,32–35 nitrofurantoin36–38 and, recently, with infliximab 39. There are anecdotal reports of associations with many other drugs including ezetimibe,40 interferon β,41 42 ornidazole,43 diclofenac,44 indomethecin,45 terbinafine,46 methyldopa,47 ranitidine,48 atorvastatin,49 fluvastatin,50 fibrates,51 adalimubab52 and after hepatitis A vaccination 53. AIH has also been reported after herbal medicines 54 55.…”

More on autoimmune hepatitis and acute hepatitis A

“…Besides, a case of AIH after HAV vaccination [13] and two overlap syndromes after combined vaccine of HAV and hepatitis B virus (one AIH/PBS and one AIH/primary sclerosing cholangitis) [14] were reported. All the clinical data and the results of the study by Abdel-Ghaffar and colleagues support an association between AIH and acute HAV infection.…”