Hepatitis C Virus Reactivation Following COVID-19 Vaccination – A Case Report

Hepatitis C Virus Reactivation Following COVID-19 Vaccination – A Case Report 

Purpose: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection impacted morbidity and mortality during the pandemic of 2020– 2021. A number of anti-COVID-19 vaccines have been developed with an unprecedented speed. While these vaccines have good efficacy and are safe, the experience with their use is limited and hence the knowledge of rare side effects. Identifying rare complications is important for future safe use of these vaccines.

Materials and Methods: Here, we report a case of a 82-year old patient with dementia who was admitted to a nursing home in the Netherlands. After vaccination with COVID-19 vaccination, physical examinations and lab tests were performed.
Results: She had a reactivation of hepatitis C infection after vaccination with the mRNA-based Pfizer–BioNTech COVID-19 vaccine. This reactivation manifested with jaundice, loss of consciousness, hepatic coma and death.
Conclusion: This reactivation of hepatitis C virus after vaccination with the Pfizer–BioNTech COVID‑19 vaccine suggests a need for critical consideration of individuals with prior HCV infection and considered for COVID-19 vaccination.

Results

On day 3 after vaccination jaundice, somnolence and chills were noticed. On clinical examination there was an obvious jaundice of skin and sclerae; her consciousness was decreased. Rectal temperature 38.1C, heart rate 92 bpm, oxygen saturation 95% [no dyspnea], blood pressure 105/93 mmHg. Two hours later rectal temperature was 37.4C, consciousness was somewhat improved, whereas other vital signs remained abnormal. Color of urine and feces was normal. Blood glucose levels were normal.

Between day 4 and 10 the patient consciousness improved and the jaundice cleared.

After day 10 of follow-up manifest jaundice again increased, accompanied by severe pain in the upper right abdomen, irradiating to the upper left abdomen, followed by loss of consciousness, coma and death on day 23. Hepatitis C was confirmed by the blood test. Patient refused treatment with hepatitis C medication.

Blood test on day 5 showed:

A second blood test on day 14 showed a decrease of bilirubin and CRP levels, but a further increase of liver enzymes AST, ALT and ALP.

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