Autoimmune hepatitis after COVID-19 vaccine

 A 65-year-old woman: diagnosed with autoimmune hepatitis after receiving the 1st dose of #CovidVaccine (Moderna). https://www.sciencedirect.com/science/article/pii/S0896841121001499?via%3Dihub

"Molecular mimicry is a potential mechanism for COVID-19 vaccine-induced autoimmunity."

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

Highlights

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A 65-year-old woman was diagnosed with autoimmune hepatitis after receiving the first dose of SARS-CoV-2 vaccine.

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Liver histology showed inflammatory portal infiltrate with interface hepatitis, centrilobular inflammation and necrosis.

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The patient showed improvement in liver function tests and normalization of IgG levels under treatment with corticosteroids.

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Molecular mimicry is a potential mechanism for COVID-19 vaccine-induced autoimmunity.

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.

After receiving the first dose of Moderna-COVID-19 vaccine, the patient presented mild abdominal pain. Two weeks later, routine liver function tests showed AST 1056U/L, ALT 1092U/L, GGT 329U/L, ALP 24U/L, total bilirubin 1.14 mg/dL. Complete blood cell count and international normalized ratio were normal. She denied recent changes in drug therapy. The serology for hepatitis A virus, human immunodeficiency virus, cytomegalovirus, Epstein-Barr virus and herpes simplex virus type 1 and 2 were all negative. Polymerase chain reaction for hepatitis B, C and E viruses were also negative. Ceruloplasmin, alpha-1 antitrypsin and iron tests were normal, as well as thyroid function. Antinuclear antibody was positive (1:100, speckled pattern), detected by indirect immunofluorescence assay on HEP-20-10 cells/monkey liver (initial dilution 1/100; final dilution 1/1000). Anti-mitochondrial, anti-smooth muscle, anti-liver-kidney microsomal, anti-soluble liver antigen and antineutrophil cytoplasmic antibodies were all negative. At this point, serum IgA, IgM and IgG levels were normal. Abdominal Doppler ultrasound showed hepatomegaly without cirrhotic morphology, and no biliary dilation or thrombosis.

Five weeks after vaccination, the patient presented with jaundice and choluria. Liver profile was worsening and IgG levels were now elevated (Fig. 1). The patient was admitted for clinical management. A percutaneous liver biopsy was performed, revealing a marked expansion of the portal tracts due to dense inflammatory infiltrate, with aggregates of plasma cells; severe interface hepatitis and multiple confluent foci of lobular necrosis were also observed (Fig. 2).

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