Development of Autoimmune Hepatitis after COVID-19 Infection in Vaccinated
Women

Ilaria      Lenci; Martina      Milana; Luca      Savino; Alessandro      Signorello; Leonardo      Baiocchi

doi:10.2174/0115748871292641240514114921

Note! Please note that this article is currently in the "Article in Press" stage and is not the final "Version of record". While it has been accepted, copy-edited, and formatted, however, it is still undergoing proofreading and corrections by the authors. Therefore, the text may still change before the final publication. Although "Articles in Press" may not have all bibliographic details available, the DOI and the year of online publication can still be used to cite them. The article title, DOI, publication year, and author(s) should all be included in the citation format. Once the final "Version of record" becomes available the "Article in Press" will be replaced by that.

Abstract

Purpose: SARS-CoV-2 infection has been associated with the impairment of several organs, including the liver. In addition, cases of autoimmune hepatitis have been described in association with COVID-19 disease. According to some case reports, vaccination has also been suggested to elicit the immune liver disorder.

Case Description: We report on the case series of two middle-aged women developing COVID-19 infection despite a completed vaccination schedule. More interestingly, the infection was followed by the onset of acute hepatitis with a significant increase in the values of liver function tests (x 10 normal values). After ruling out the main causes of liver damage (viral, toxic, etc.), a diagnosis of autoimmune hepatitis was made and supported by liver histology in both cases. The clinical picture was quickly reverted with immunosuppressive (steroid) therapy, also confirming the diagnosis.

Conclusion: We observed a possible relationship between COVID-19 infection and the onset of autoimmune hepatitis and also described this occurrence in vaccinated subjects. It remains to be clarified whether repeated exposure to viral antigens (vaccination plus true infection) or specific emerging viral genotype (omicron strain) may facilitate the onset of this immune liver disease.

[1]
Berlin DA, Gulick RM, Martinez FJ. Severe covid-19. N Engl J Med  2020; 383(25): 2451-60.
 [http://dx.doi.org/10.1056/NEJMcp2009575] [PMID: 32412710]

[2]
Ramos-Casals M, Brito-Zerón P, Mariette X. Systemic and organ-specific immune-related manifestations of COVID-19. Nat Rev Rheumatol  2021; 17(6): 315-32.
 [http://dx.doi.org/10.1038/s41584-021-00608-z] [PMID: 33903743]

[3]
Signorello A, Lenci I, Milana M, Grassi G, Baiocchi L. COVID-19 in normal, diseased and transplanted liver. World J Gastroenterol  2021; 27(20): 2576-85.
 [http://dx.doi.org/10.3748/wjg.v27.i20.2576] [PMID: 34092976]

[4]
Tanaka A. Autoimmune hepatitis: 2019 update. Gut liver  2020; 14(4): 430-8.
 [http://dx.doi.org/10.5009/gnl19261] [PMID: 32301319]

[5]
Muratori L, Longhi MS. The interplay between regulatory and effector T cells in autoimmune hepatitis: Implications for innovative treatment strategies. J Autoimmun  2013; 46: 74-80.
 [http://dx.doi.org/10.1016/j.jaut.2013.06.016] [PMID: 23871639]

[6]
Poddighe D, Maulenkul T, Zhubanova G, Akhmaldtinova L, Dossybayeva K. Natural killer T (NKT) cells in autoimmune hepatitis: Current evidence from basic and clinical research. Cells  2023; 12(24): 2854.
 [http://dx.doi.org/10.3390/cells12242854] [PMID: 38132174]

[7]
Marjot T, Buescher G, Sebode M, et al. SARS-CoV-2 infection in patients with autoimmune hepatitis. J Hepatol  2021; 74(6): 1335-43.
 [http://dx.doi.org/10.1016/j.jhep.2021.01.021] [PMID: 33508378]

[8]
Duengelhoef P, Hartl J, Rüther D, et al. SARS-CoV-2 vaccination response in patients with autoimmune hepatitis and autoimmune cholestatic liver disease. United European Gastroenterol J  2022; 10(3): 319-29.
 [http://dx.doi.org/10.1002/ueg2.12218] [PMID: 35289983]

[9]
Chow KW, Pham NV, Ibrahim BM, Hong K, Saab S. Autoimmune hepatitis-like syndrome following covid-19 vaccination: A systematic review of the literature. Dig Dis Sci  2022; 67(9): 4574-80.
 [http://dx.doi.org/10.1007/s10620-022-07504-w] [PMID: 35486203]

[10]
Boettler T, Csernalabics B, Salié H, et al. SARS-CoV-2 vaccination can elicit a CD8 T-cell dominant hepatitis. J Hepatol  2022; 77(3): 653-9.
 [http://dx.doi.org/10.1016/j.jhep.2022.03.040] [PMID: 35461912]

[11]
Terziroli Beretta-Piccoli B, Mieli-Vergani G, Vergani D. Autoimmmune hepatitis. Cell Mol Immunol  2022; 19(2): 158-76.
 [http://dx.doi.org/10.1038/s41423-021-00768-8] [PMID: 34580437]

[12]
Wraith DC, Goldman M, Lambert PH. Vaccination and autoimmune disease: What is the evidence? Lancet  2003; 362(9396): 1659-66.
 [http://dx.doi.org/10.1016/S0140-6736(03)14802-7] [PMID: 14630450]

[13]
Chen Y, Xu Z, Wang P, et al. New-onset autoimmune phenomena post-COVID-19 vaccination. Immunology  2022; 165(4): 386-401.
 [http://dx.doi.org/10.1111/imm.13443] [PMID: 34957554]

[14]
Boccia S, Ricciardi W, Ioannidis JPA. What other countries can learn from Italy during the COVID-19 pandemic. JAMA Intern Med  2020; 180(7): 927-8.
 [http://dx.doi.org/10.1001/jamainternmed.2020.1447] [PMID: 32259190]

[15]
Mathieu E, Ritchie H, Ortiz-Ospina E, et al. A global database of COVID-19 vaccinations. Nat Hum Behav  2021; 5(7): 947-53.
 [http://dx.doi.org/10.1038/s41562-021-01122-8] [PMID: 33972767]

[16]
Lodato F, Larocca A, D’Errico A, Cennamo V. An unusual case of acute cholestatic hepatitis after m-RNABNT162b2 (Comirnaty) SARS-CoV-2 vaccine: Coincidence, autoimmunity or drug-related liver injury. J Hepatol  2021; 75(5): 1254-6.
 [http://dx.doi.org/10.1016/j.jhep.2021.07.005] [PMID: 34256064]

[17]
Rocco A, Sgamato C, Compare D, Nardone G. Autoimmune hepatitis following SARS-CoV-2 vaccine: May not be a casuality. J Hepatol  2021; 75(3): 728-9.
 [http://dx.doi.org/10.1016/j.jhep.2021.05.038] [PMID: 34116081]

[18]
Sundaresan B, Shirafkan F, Ripperger K, Rattay K. The role of viral infections in the onset of autoimmune diseases. Viruses  2023; 15(3): 782.
 [http://dx.doi.org/10.3390/v15030782] [PMID: 36992490]

[19]
Lenci I, Carnì P, Milana M, Bicaj A, Signorello A, Baiocchi L. Sequence of events leading to primary biliary cholangitis. World J Gastroenterol  2023; 29(37): 5305-12.
 [http://dx.doi.org/10.3748/wjg.v29.i37.5305] [PMID: 37899786]

[20]
Durazo FA, Kristbaum K, Miller J, Saeian K, Selim M, Hong JC. De novo autoimmune hepatitis after COVID-19 infection in an unvaccinated patient. Case Reports Hepatol  2022; 2022: 1-5.
 [http://dx.doi.org/10.1155/2022/8409269] [PMID: 36590671]

[21]
Liu Y, Ebinger JE, Mostafa R, et al. Paradoxical sex-specific patterns of autoantibody response to SARS-CoV-2 infection. J Transl Med  2021; 19(1): 524.
 [http://dx.doi.org/10.1186/s12967-021-03184-8] [PMID: 34965855]

[22]
Chang R, Yen-Ting Chen T, Wang SI, Hung YM, Chen HY, Wei CCJ. Risk of autoimmune diseases in patients with COVID-19: A retrospective cohort study. EClinicalMedicine  2023; 56: 101783.
 [http://dx.doi.org/10.1016/j.eclinm.2022.101783] [PMID: 36643619]

Rights & Permissions Print Cite

Journal Information

For Authors

For Editors

For Reviewers

Explore Articles

Open Access

Open Access Articles

For Visitors

DOI https://dx.doi.org/10.2174/0115748871292641240514114921	Print ISSN 1574-8871
Publisher Name Bentham Science Publisher	Online ISSN 1876-1038

Reviews on Recent Clinical Trials

Development of Autoimmune Hepatitis after COVID-19 Infection in Vaccinated Women

Abstract Play Pause

Related Journals

Related Books

Abstract