Exacerbation of Autoimmune Hepatitis following Inactivated SARSCoV- 2 Vaccination
DOI:
https://doi.org/10.31584/jhsmr.20241030Keywords:
autoimmune hepatitis (AIH), COVID-19, liver, SARS-CoV-2, vaccinationAbstract
Autoimmune hepatitis (AIH) is a rare condition that has seldom been reported being reactivated by a coronavirus disease 2019 (COVID-19) vaccination, especially from an inactivated vaccine. This report presents the case of a 64-year-old male with quiescent AIH cirrhosis who exhibited jaundice and constitutional symptoms for three days at two weeks following his second dose of an inactivated vaccine. The patient had complied well with a four-year immunosuppressive medication regimen to treat AIH which maintained normalized liver enzymes. He also abstained from using herbal supplements. At his presentation, his liver chemistry showed acute hepatocellular jaundice, with histology revealing active AIH. Following extensive testing, he was diagnosed with an AIH exacerbation triggered by the COVID-19 vaccine. His symptoms improved following treatment with higher doses of immunosuppressive agents. This report underscores the potential effect of the COVID-19 vaccine on reactivating well-controlled AIH.
References
Zhao J, Zhao S, Ou J, Zhang J, Lan W, Guan W, et al. Covid-19: coronavirus vaccine development updates. Front Immunol 2020;11:602256.
Freeman D, Loe BS, Yu LM, Freeman J, Chadwick A, Vaccari C, et al. Effects of different types of written vaccination information on COVID-19 vaccine hesitancy in the UK (OCEANS-III): a single-blind, parallel-group, randomised controlled trial. Lancet Public Health 2021;6:e416–27.
Teijaro JR, Farber DL. COVID-19 vaccines: modes of immune activation and future challenges. Nat Rev Immunol 2021;21:195–7.
Dighriri IM, Alhusayni KM, Mobarki AY, Aljerary IS, Alqurashi KA, Aljuaid FA, et al. Pfizer-biontech covid-19 vaccine (bnt162b2) side effects: a systematic review. Cureus 2022;14:e23526.
Camacho-Domínguez L, Rodríguez Y, Polo F, Restrepo Gutierrez JC, Zapata E, Rojas M, et al. COVID-19 vaccine and autoimmunity. a new case of autoimmune hepatitis and review of the literature. J Transl Autoimmun 2022;5:100140.
De Michele M, Kahan J, Berto I, Schiavo OG, Iacobucci M, Toni D, et al. Cerebrovascular Complications of COVID-19 and COVID-19 Vaccination. Circ Res 2022;130:1187–203.
Avci E, Abasiyanik F. Autoimmune hepatitis after SARS-CoV-2 vaccine: New-onset or flare-up? J Autoimmun 2021;125:102745.
Bril F, Al Diffalha S, Dean M, Fettig DM. Autoimmune hepatitis developing after coronavirus disease 2019 (COVID-19) vaccine: causality or casualty? J Hepatol. 2021;75:222–4.
Clayton-Chubb D, Schneider D, Freeman E, Kemp W, Roberts SK. Autoimmune hepatitis developing after the ChAdOx1 nCoV-19 (Oxford-AstraZeneca) vaccine. J Hepatol 2021 ;75:1249–50.
Garrido I, Lopes S, Simões MS, Liberal R, Lopes J, Carneiro F, et al. Autoimmune hepatitis after COVID-19 vaccine - more than a coincidence. J Autoimmun 2021;125:102741.
Rela M, Jothimani D, Vij M, Rajakumar A, Rammohan A. Auto-immune hepatitis following COVID vaccination. J Autoimmun 2021;123:102688.
Domerecka W, Kowalska-Kępczyńska A, Michalak A, Homa-Mlak I, Mlak R, Cichož-Lach H, et al. Etiopathogenesis and diagnostic strategies in autoimmune hepatitis. Diagnostics (Basel) 2021;11:1418.
European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Autoimmune hepatitis. J Hepatol 2015;63:971–1004.
Perumalswami P, Peng L, Odin JA. Vaccination as a triggering event for autoimmune hepatitis. Semin Liver Dis 2009;29:331–4.
Codoni G, Kirchner T, Engel B, Villamil AM, Efe C, Stättermayer AF, et al. Histological and serological features of acute liver injury after SARS-CoV-2 vaccination. JHEP Rep 2023;5:100605.
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
