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Xie X, Zhong L, Gan X, Liu Y, Zhu Y, Chen B, Yu H. Autoimmune hepatitis collapsed after the COVID-19 vaccination. Clin Res Hepatol Gastroenterol 2023; 47:102226. [PMID: 37844776 DOI: 10.1016/j.clinre.2023.102226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 10/18/2023]
Affiliation(s)
- XiaoYue Xie
- Department of Gastroenterology, The Second Affifiliated Hospital of Chongqing Medical University, Yuzhong District, Chongqing, China
| | - Li Zhong
- Department of Gastroenterology, The Second Affifiliated Hospital of Chongqing Medical University, Yuzhong District, Chongqing, China
| | - XiaYu Gan
- Department of Gastroenterology, The Second Affifiliated Hospital of Chongqing Medical University, Yuzhong District, Chongqing, China
| | - Yi Liu
- Department of Gastroenterology, The Second Affifiliated Hospital of Chongqing Medical University, Yuzhong District, Chongqing, China
| | - YuLan Zhu
- Department of Gastroenterology, The Second Affifiliated Hospital of Chongqing Medical University, Yuzhong District, Chongqing, China
| | - BoShi Chen
- Department of Gastroenterology, The Second Affifiliated Hospital of Chongqing Medical University, Yuzhong District, Chongqing, China
| | - HuiHong Yu
- Department of Gastroenterology, The Second Affifiliated Hospital of Chongqing Medical University, Yuzhong District, Chongqing, China.
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Bernasconi E, Biagi M, Di Agostino S, Cursaro C, Felicani C, Ronconi E, Franchi E, Costanzo AC, Gabrielli F, Cavicchioli A, Ienopoli G, Marenghi P, Bartoli A, Serra B, Scalabrini D, Sighinolfi P, Andreone P. Investigating Acute Hepatitis after SARS-CoV-2 Vaccination or Infection: A Genetic Case Series. Biomedicines 2023; 11:2848. [PMID: 37893221 PMCID: PMC10604753 DOI: 10.3390/biomedicines11102848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/14/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
(1) Background: Despite the advantages of COVID-19 vaccination, rare cases of acute hepatitis developing after the administration of the COVID-19 vaccine or the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been reported. The aim of the study is to describe a case series of patients who experienced the onset of acute hepatitis, with or without autoimmune features, following SARS-CoV-2 vaccination or infection and to hypothesize a genetic susceptibility in the pathogenesis. (2) Methods: A group of patients with acute onset hepatitis following SARS-CoV-2 vaccination or infection were evaluated in our hepatology outpatient clinic, where they underwent biochemical and autoimmune tests. Hepatitis A (HAV), B (HBV), and C virus (HCV), cytomegalovirus (CMV), Epstein-Barr virus (EBV), and human immunodeficiency virus (HIV) infections were excluded. Patients with a diagnosis of autoimmune hepatitis (AIH) or drug-induced liver injury (DILI) underwent HLA typing and histological testing. (3) Results: Five patients experienced new-onset AIH after COVID-19 vaccination, one of which developed mild symptoms after vaccination that strongly worsened during subsequent SARS-CoV-2 infection. One patient had AIH relapse after COVID-19 vaccination while on maintenance immunosuppressive treatment. All of them had HLA DRB1 alleles known to confer susceptibility to AIH (HLA DRB1*03,*07,*13,*14), and in three of them, HLA DRB1*11 was also detected. Two patients developed acute hepatitis without autoimmune hallmarks which resolved spontaneously, both positive for HLA DRB1*11. (4) Conclusions: An association between AIH and COVID-19 vaccine or infection can be hypothesized in individuals with a genetic predisposition. In patients without autoimmune features and spontaneous improvement of hypertransaminasemia, the diagnosis of drug-induced liver injury (DILI) is probable. Further studies are needed to determine the presence of an actual association and identify a possible role of HLA DRB1*11 in the pathogenesis of acute liver injury after SARS-CoV2 vaccination or infection.
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Affiliation(s)
- Elisa Bernasconi
- Department of Internal Medicine, Civil Hospital of Baggiovara, University of Modena and Reggio Emilia, Baggiovara, 41126 Modena, Italy; (E.B.); (M.B.); (S.D.A.); (C.C.); (C.F.); (E.R.); (E.F.); (A.C.C.); (F.G.); (A.C.); (G.I.); (P.M.); (A.B.); (B.S.); (D.S.); (P.S.)
| | - Matteo Biagi
- Department of Internal Medicine, Civil Hospital of Baggiovara, University of Modena and Reggio Emilia, Baggiovara, 41126 Modena, Italy; (E.B.); (M.B.); (S.D.A.); (C.C.); (C.F.); (E.R.); (E.F.); (A.C.C.); (F.G.); (A.C.); (G.I.); (P.M.); (A.B.); (B.S.); (D.S.); (P.S.)
| | - Stefania Di Agostino
- Department of Internal Medicine, Civil Hospital of Baggiovara, University of Modena and Reggio Emilia, Baggiovara, 41126 Modena, Italy; (E.B.); (M.B.); (S.D.A.); (C.C.); (C.F.); (E.R.); (E.F.); (A.C.C.); (F.G.); (A.C.); (G.I.); (P.M.); (A.B.); (B.S.); (D.S.); (P.S.)
| | - Carmela Cursaro
- Department of Internal Medicine, Civil Hospital of Baggiovara, University of Modena and Reggio Emilia, Baggiovara, 41126 Modena, Italy; (E.B.); (M.B.); (S.D.A.); (C.C.); (C.F.); (E.R.); (E.F.); (A.C.C.); (F.G.); (A.C.); (G.I.); (P.M.); (A.B.); (B.S.); (D.S.); (P.S.)
| | - Cristina Felicani
- Department of Internal Medicine, Civil Hospital of Baggiovara, University of Modena and Reggio Emilia, Baggiovara, 41126 Modena, Italy; (E.B.); (M.B.); (S.D.A.); (C.C.); (C.F.); (E.R.); (E.F.); (A.C.C.); (F.G.); (A.C.); (G.I.); (P.M.); (A.B.); (B.S.); (D.S.); (P.S.)
| | - Enrico Ronconi
- Department of Internal Medicine, Civil Hospital of Baggiovara, University of Modena and Reggio Emilia, Baggiovara, 41126 Modena, Italy; (E.B.); (M.B.); (S.D.A.); (C.C.); (C.F.); (E.R.); (E.F.); (A.C.C.); (F.G.); (A.C.); (G.I.); (P.M.); (A.B.); (B.S.); (D.S.); (P.S.)
| | - Elena Franchi
- Department of Internal Medicine, Civil Hospital of Baggiovara, University of Modena and Reggio Emilia, Baggiovara, 41126 Modena, Italy; (E.B.); (M.B.); (S.D.A.); (C.C.); (C.F.); (E.R.); (E.F.); (A.C.C.); (F.G.); (A.C.); (G.I.); (P.M.); (A.B.); (B.S.); (D.S.); (P.S.)
| | - Arianna Carmen Costanzo
- Department of Internal Medicine, Civil Hospital of Baggiovara, University of Modena and Reggio Emilia, Baggiovara, 41126 Modena, Italy; (E.B.); (M.B.); (S.D.A.); (C.C.); (C.F.); (E.R.); (E.F.); (A.C.C.); (F.G.); (A.C.); (G.I.); (P.M.); (A.B.); (B.S.); (D.S.); (P.S.)
| | - Filippo Gabrielli
- Department of Internal Medicine, Civil Hospital of Baggiovara, University of Modena and Reggio Emilia, Baggiovara, 41126 Modena, Italy; (E.B.); (M.B.); (S.D.A.); (C.C.); (C.F.); (E.R.); (E.F.); (A.C.C.); (F.G.); (A.C.); (G.I.); (P.M.); (A.B.); (B.S.); (D.S.); (P.S.)
| | - Alessia Cavicchioli
- Department of Internal Medicine, Civil Hospital of Baggiovara, University of Modena and Reggio Emilia, Baggiovara, 41126 Modena, Italy; (E.B.); (M.B.); (S.D.A.); (C.C.); (C.F.); (E.R.); (E.F.); (A.C.C.); (F.G.); (A.C.); (G.I.); (P.M.); (A.B.); (B.S.); (D.S.); (P.S.)
| | - Giuseppe Ienopoli
- Department of Internal Medicine, Civil Hospital of Baggiovara, University of Modena and Reggio Emilia, Baggiovara, 41126 Modena, Italy; (E.B.); (M.B.); (S.D.A.); (C.C.); (C.F.); (E.R.); (E.F.); (A.C.C.); (F.G.); (A.C.); (G.I.); (P.M.); (A.B.); (B.S.); (D.S.); (P.S.)
| | - Paolo Marenghi
- Department of Internal Medicine, Civil Hospital of Baggiovara, University of Modena and Reggio Emilia, Baggiovara, 41126 Modena, Italy; (E.B.); (M.B.); (S.D.A.); (C.C.); (C.F.); (E.R.); (E.F.); (A.C.C.); (F.G.); (A.C.); (G.I.); (P.M.); (A.B.); (B.S.); (D.S.); (P.S.)
| | - Alessandra Bartoli
- Department of Internal Medicine, Civil Hospital of Baggiovara, University of Modena and Reggio Emilia, Baggiovara, 41126 Modena, Italy; (E.B.); (M.B.); (S.D.A.); (C.C.); (C.F.); (E.R.); (E.F.); (A.C.C.); (F.G.); (A.C.); (G.I.); (P.M.); (A.B.); (B.S.); (D.S.); (P.S.)
| | - Beatrice Serra
- Department of Internal Medicine, Civil Hospital of Baggiovara, University of Modena and Reggio Emilia, Baggiovara, 41126 Modena, Italy; (E.B.); (M.B.); (S.D.A.); (C.C.); (C.F.); (E.R.); (E.F.); (A.C.C.); (F.G.); (A.C.); (G.I.); (P.M.); (A.B.); (B.S.); (D.S.); (P.S.)
| | - Davide Scalabrini
- Department of Internal Medicine, Civil Hospital of Baggiovara, University of Modena and Reggio Emilia, Baggiovara, 41126 Modena, Italy; (E.B.); (M.B.); (S.D.A.); (C.C.); (C.F.); (E.R.); (E.F.); (A.C.C.); (F.G.); (A.C.); (G.I.); (P.M.); (A.B.); (B.S.); (D.S.); (P.S.)
| | - Pamela Sighinolfi
- Department of Internal Medicine, Civil Hospital of Baggiovara, University of Modena and Reggio Emilia, Baggiovara, 41126 Modena, Italy; (E.B.); (M.B.); (S.D.A.); (C.C.); (C.F.); (E.R.); (E.F.); (A.C.C.); (F.G.); (A.C.); (G.I.); (P.M.); (A.B.); (B.S.); (D.S.); (P.S.)
| | - Pietro Andreone
- Department of Internal Medicine, Civil Hospital of Baggiovara, University of Modena and Reggio Emilia, Baggiovara, 41126 Modena, Italy; (E.B.); (M.B.); (S.D.A.); (C.C.); (C.F.); (E.R.); (E.F.); (A.C.C.); (F.G.); (A.C.); (G.I.); (P.M.); (A.B.); (B.S.); (D.S.); (P.S.)
- Department of Internal Medicine, General, Emergency and Post-Acute, Division of Metabolic Internal Medicine, Civil Hospital of Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Baggiovara, 41126 Modena, Italy
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Moriya K, Nakakita T, Nakayama N, Matsuo Y, Komeda Y, Hanatani J, Kaya D, Nagamatsu S, Matsuo H, Uejima M, Nakamura F. SARS-CoV-2 Vaccination Response in Japanese Patients with Autoimmune Hepatitis: Results of Propensity Score-Matched Case-Control Study. J Clin Med 2023; 12:5411. [PMID: 37629453 PMCID: PMC10455609 DOI: 10.3390/jcm12165411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/18/2023] [Accepted: 08/19/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND/AIMS Although the World Health Organization declared the end of the public health emergency of international concern focusing on COVID-19 in May 2023, this bothersome virus continues to mutate, and the possibility of the emergence of mutant strains with high infectivity and severe disease rates has not disappeared. Thus, medical evidence must be accumulated, which is indispensable for protecting both patients under immunosuppressive treatments and the healthy population. This study examined SARS-CoV-2 vaccination responses in Japanese patients with autoimmune hepatitis (AIH) compared with healthy controls. METHODS This observational study registered 22 patients with histologically diagnosed AIH and 809 healthy controls in our hospital. Their Elecsys anti-SARS-CoV-2 spike antibody concentrations before and after vaccination were evaluated. RESULTS In this study, 72.7% and 18.2% of patients with AIH received steroids and azathioprine, respectively. Significant negative correlations were found between age and anti-SARS-CoV-2 spike antibody concentration in both groups; however, no sex differences were found. Although anti-SARS-CoV-2 spike antibody concentration was drastically augmented after the second vaccination (p < 0.05) in the AIH group, these levels were significantly lower than those in the controls (p < 0.05). In the age- and sex-matched analysis, the population ratio with a minimum response (≤100 binding antibody units (BAU/mL) was higher among patients with AIH than among controls 26 weeks after the second vaccination (44% vs. 7%, p < 0.05). CONCLUSIONS The anti-SARS-CoV-2 spike antibody concentration in AIH patients was significantly lower than that in controls after the second vaccination. Continued and widespread vaccination, particularly for patients requiring medical immunomodulation, is recommended.
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Affiliation(s)
- Kei Moriya
- Department of Gastroenterology, Nara Prefecture General Medical Center, Nara 630-8581, Japan; (Y.M.)
- Department of Gastroenterology, Nara Medical University, Nara 634-8521, Japan
| | - Tomoko Nakakita
- Department of Laboratory Medicine, Nara Prefecture General Medical Center, Nara 630-8581, Japan
| | - Natsuki Nakayama
- Department of Laboratory Medicine, Nara Prefecture General Medical Center, Nara 630-8581, Japan
| | - Yuya Matsuo
- Department of Gastroenterology, Nara Prefecture General Medical Center, Nara 630-8581, Japan; (Y.M.)
| | - Yusuke Komeda
- Department of Gastroenterology, Nara Prefecture General Medical Center, Nara 630-8581, Japan; (Y.M.)
- Department of Gastroenterology, Nara Medical University, Nara 634-8521, Japan
| | - Junichi Hanatani
- Department of Gastroenterology, Nara Prefecture General Medical Center, Nara 630-8581, Japan; (Y.M.)
- Department of Gastroenterology, Nara Medical University, Nara 634-8521, Japan
| | - Daisuke Kaya
- Department of Gastroenterology, Nara Prefecture General Medical Center, Nara 630-8581, Japan; (Y.M.)
- Department of Gastroenterology, Nara Medical University, Nara 634-8521, Japan
| | - Shinsaku Nagamatsu
- Department of Gastroenterology, Nara Prefecture General Medical Center, Nara 630-8581, Japan; (Y.M.)
- Department of Gastroenterology, Nara Medical University, Nara 634-8521, Japan
| | - Hideki Matsuo
- Department of Gastroenterology, Nara Prefecture General Medical Center, Nara 630-8581, Japan; (Y.M.)
- Department of Gastroenterology, Nara Medical University, Nara 634-8521, Japan
| | - Masakazu Uejima
- Department of Gastroenterology, Nara Medical University, Nara 634-8521, Japan
- Department of Diabetes and Endocrinology, Nara Prefecture General Medical Center, Nara 630-8581, Japan
| | - Fumihiko Nakamura
- Department of Laboratory Medicine, Nara Prefecture General Medical Center, Nara 630-8581, Japan
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Zhou H, Ye Q. Clinical Features of COVID-19 Vaccine-Associated Autoimmune Hepatitis: A Systematic Review. Diseases 2023; 11:80. [PMID: 37366868 DOI: 10.3390/diseases11020080] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/17/2023] [Accepted: 05/24/2023] [Indexed: 06/28/2023] Open
Abstract
Autoimmune hepatitis (AIH) is an inflammatory liver disease wherein the body's immune system instigates an attack on the liver, causing inflammation and hepatic impairment. This disease usually manifests in genetically predisposed individuals and is triggered by stimuli or environments such as viral infections, environmental toxins, and drugs. The causal role of COVID-19 vaccination in AIH remains uncertain. This review of 39 cases of vaccine-related AIH indicates that female patients above the age of 50 years or those with potential AIH risk factors may be susceptible to vaccine-related AIH, and the clinical features of vaccine-associated AIH are similar to those of idiopathic AIH. These features commonly manifest in patients after the first dose of vaccination, with symptom onset typically delayed by 10-14 days. The incidence of underlying liver disease in patients with potential health conditions associated to liver disease is similar to that of patients without preexisting illnesses. Steroid administration is effective in treating vaccine-related AIH-susceptible patients, with most patients experiencing improvement in their clinical symptoms. However, care should be taken to prevent bacterial infections during drug administration. Furthermore, the possible pathogenic mechanisms of vaccine-associated AIH are discussed to offer potential ideas for vaccine development and enhancement. Although the incidence of vaccine-related AIH is rare, individuals should not be deterred from receiving the COVID-19 vaccine, as the benefits of vaccination significantly outweigh the risks.
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Affiliation(s)
- Hao Zhou
- Department of Laboratory Medicine, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou 310000, China
| | - Qing Ye
- Department of Laboratory Medicine, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou 310000, China
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Guo M, Liu X, Chen X, Li Q. Insights into new-onset autoimmune diseases after COVID-19 vaccination. Autoimmun Rev 2023; 22:103340. [PMID: 37075917 PMCID: PMC10108562 DOI: 10.1016/j.autrev.2023.103340] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 04/13/2023] [Indexed: 04/21/2023]
Abstract
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has resulted in more than 670 million infections and almost 7 million deaths globally. The emergence of numerous SARS-CoV-2 has heightened public concern regarding the future course of the epidemic. Currently, the SARS-CoV-2 Omicron variant has rapidly become globally dominant in the COVID-19 pandemic due to its high infectivity and immune evasion. Consequently, vaccination implementation is critically significant. However, growing evidence suggests that COVID-19 vaccination may cause new-onset autoimmune diseases, including autoimmune glomerulonephritis, autoimmune rheumatic diseases, and autoimmune hepatitis. Nevertheless, the causal relationship between COVID-19 vaccines and these autoimmune diseases remains to be demonstrated. In this review, we provide evidence that vaccination induces autoimmunity and summarize possible mechanisms of action, such as molecular mimicry, activation by bystanders, and adjuvants. Our objective is not to refute the importance of vaccines, but to raise awareness about the potential risks of COVID-19 vaccination. In fact, we believe that the benefits of vaccination far outweigh the possible risks and encourage people to get vaccinated.
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Affiliation(s)
- Ming Guo
- Hebei General Hosptial, Shijiazhuang, China; Hebei Medical University, Shijiazhuang, China
| | - Xiaoxiao Liu
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing 100853, China
| | - Xiangmei Chen
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing 100853, China
| | - Qinggang Li
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing 100853, China.
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Ueno M, Takabatake H, Itakura J, Fujita R, Kayahara T, Morimoto Y, Notohara K, Mizuno M. Corticosteroid-refractory autoimmune hepatitis after COVID-19 vaccination: a case report and literature review. Clin J Gastroenterol 2023:10.1007/s12328-023-01794-x. [PMID: 37029249 PMCID: PMC10081821 DOI: 10.1007/s12328-023-01794-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/27/2023] [Indexed: 04/09/2023]
Abstract
Several vaccines have been developed for coronavirus disease 2019 (COVID-19) and are used worldwide. Here we report a case of severe acute hepatitis induced by COVID-19 vaccination. A 54-year-old woman received two doses of the Pfizer-BioNTech COVID-19 mRNA vaccine and an additional dose of the Moderna COVID-19 mRNA vaccine. Seven days after the third dose, she noticed fatigue, appetite loss and dark urine. Laboratory tests were consistent with severe liver injury and jaundice. Anti-smooth muscle antibody and HLA-DR4 were positive; thus, we suspected that she had autoimmune hepatitis (AIH). Intravenous methylprednisolone followed by oral prednisolone were administered. Because remission was not achieved, we performed percutaneous liver biopsy. Histologically, pan-lobular inflammation with moderate infiltration of lymphocytes and macrophages, interface hepatitis, and rosette formation were present. We regarded these findings as confirmation of the diagnosis of AIH. As she had not responded to corticosteroids, we added azathioprine. Liver biochemistry tests gradually improved, and prednisolone could be tapered without relapse of AIH. Dozens of cases of AIH after COVID-19 vaccination have been reported. Corticosteroids were effective in most cases, but some patients have died from liver failure after vaccination. This case illustrates the efficacy of azathioprine for steroid-refractory AIH induced by COVID-19 vaccination.
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Affiliation(s)
- Masayuki Ueno
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan.
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Hiroyuki Takabatake
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Junya Itakura
- Department of Anatomic Pathology, Kurashiki Central Hospital, Okayama, Japan
| | - Rio Fujita
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan
- Department of Gastroenterology, Okayama City Hospital, Okayama, Japan
| | - Takahisa Kayahara
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Youichi Morimoto
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Kenji Notohara
- Department of Anatomic Pathology, Kurashiki Central Hospital, Okayama, Japan
| | - Motowo Mizuno
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan
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Sgamato C, Rocco A, Compare D, Minieri S, Marchitto SA, Maurea S, Nardone G. Autoimmune liver diseases and SARS-CoV-2. World J Gastroenterol 2023; 29:1838-1851. [PMID: 37032727 PMCID: PMC10080695 DOI: 10.3748/wjg.v29.i12.1838] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/12/2023] [Accepted: 03/14/2023] [Indexed: 03/28/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causing coronavirus disease 2019 (COVID-19), can trigger autoimmunity in genetically predisposed individuals through hyperstimulation of immune response and molecular mimicry. Here we summarise the current knowledge about auto-immune liver diseases (AILDs) and SARS-CoV-2, focusing on: (1) The risk of SARS-CoV-2 infection and the course of COVID-19 in patients affected by AILDs; (2) the role of SARS-CoV-2 in inducing liver damage and triggering AILDs; and (3) the ability of vaccines against SARS-CoV-2 to induce autoimmune responses in the liver. Data derived from the literature suggest that patients with AILDs do not carry an increased risk of SARS-Cov-2 infection but may develop a more severe course of COVID-19 if on treatment with steroids or thiopurine. Although SARS-CoV-2 infection can lead to the development of several autoimmune diseases, few reports correlate it to the appearance of de novo manifestation of immune-mediated liver diseases such as autoimmune hepatitis (AIH), primary biliary cholangitis (PBC) or AIH/PBC overlap syndrome. Different case series of an AIH-like syndrome with a good prognosis after SARS-CoV-2 vaccination have been described. Although the causal link between SARS-CoV-2 vaccines and AIH cannot be definitively established, these reports suggest that this association could be more than coincidental.
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Affiliation(s)
- Costantino Sgamato
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy
| | - Alba Rocco
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy
| | - Debora Compare
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy
| | - Stefano Minieri
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy
| | - Stefano Andrea Marchitto
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy
| | - Simone Maurea
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples 80131, Italy
| | - Gerardo Nardone
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy
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Ozaka S, Kobayashi T, Mizukami K, Murakami K. COVID-19 vaccination and liver disease. World J Gastroenterol 2022; 28:6791-6810. [PMID: 36632314 PMCID: PMC9827578 DOI: 10.3748/wjg.v28.i48.6791] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/07/2022] [Accepted: 12/06/2022] [Indexed: 12/26/2022] Open
Abstract
Various vaccines against severe acute respiratory syndrome coronavirus 2 have been developed in response to the coronavirus disease 2019 (COVID-19) global pandemic, several of which are highly effective in preventing COVID-19 in the general population. Patients with chronic liver diseases (CLDs), particularly those with liver cirrhosis, are considered to be at a high risk for severe COVID-19 and death. Given the increased rates of disease severity and mortality in patients with liver disease, there is an urgent need to understand the efficacy of vaccination in this population. However, the data regarding efficacy and safety of COVID-19 vaccination in patients with CLDs is limited. Indeed, several organ-specific or systemic immune-mediated side effects following COVID-19 vaccination, including liver injury similar to autoimmune hepatitis, have been recently reported. Although the number of cases of vaccine-related liver injury is increasing, its frequency, clinical course, and mechanism remain unclear. Here, we review the current findings on COVID-19 vaccination and liver disease, focusing on: (1) The impact of COVID-19 in patients with CLD; (2) The efficacy, safety, and risk-benefit profiles of COVID-19 vaccines in patients with CLD; and (3) Liver injury following COVID-19 vaccination.
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Affiliation(s)
- Sotaro Ozaka
- Department of Gastroenterology, Faculty of Medicine, Oita University, Yufu 879-5593, Oita, Japan
- Department of Infectious Disease Control, Faculty of Medicine, Oita University, Yufu 879-5593, Oita, Japan
| | - Takashi Kobayashi
- Department of Infectious Disease Control, Faculty of Medicine, Oita University, Yufu 879-5593, Oita, Japan
| | - Kazuhiro Mizukami
- Department of Gastroenterology, Faculty of Medicine, Oita University, Yufu 879-5593, Oita, Japan
| | - Kazunari Murakami
- Department of Gastroenterology, Faculty of Medicine, Oita University, Yufu 879-5593, Oita, Japan
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9
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Vaccine-Related Autoimmune Hepatitis: Emerging Association with SARS-CoV-2 Vaccination or Coincidence? Vaccines (Basel) 2022; 10:vaccines10122073. [PMID: 36560483 PMCID: PMC9783100 DOI: 10.3390/vaccines10122073] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND There is an increasing number of liver injury cases resembling autoimmune hepatitis (AIH) following SARS-CoV-2 vaccination; however, an association has not yet been established. METHODS/MATERIALS A literature review was performed to identify articles regarding the association of AIH with vaccination, emphasizing on SARS-CoV-2 vaccines, and the proposed mechanisms. We then performed a literature search for AIH-like cases following SARS-CoV-2 vaccination, and we evaluated the included cases for AIH diagnosis using simplified diagnostic criteria (SDC), and for vaccination causality using the Naranjo score for adverse drug reactions. RESULTS We identified 51 AIH-like cases following SARS-CoV-2 vaccination. Forty cases (80%) were characterized as "probable", "at least probable", or "definite" for AIH diagnosis according to SDC. Forty cases (78.4%) were characterized as "probable", four (7.8%) as "possible", and three (5.8%) as "definite" for vaccine-related AIH according to the Naranjo score. CONCLUSION SARS-CoV-2 vaccine-related AIH carries several phenotypes and, although most cases resolve, immunosuppressive therapy seems to be necessary. Early diagnosis is mandatory and should be considered in any patient with acute or chronic hepatitis after SARS-CoV-2 vaccination, especially in those with pre-existing liver disease.
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10
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Noureldine HA, Maamari J, El Helou MO, Chedid G, Farra A, Husni R, Mokhbat JE. The effect of the BNT162b2 vaccine on antinuclear antibody and antiphospholipid antibody levels. Immunol Res 2022; 70:800-810. [PMID: 35978253 PMCID: PMC9385410 DOI: 10.1007/s12026-022-09309-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/20/2022] [Indexed: 11/05/2022]
Abstract
The Food and Drug Administration (FDA) approved the first SARS-CoV-2 mRNA vaccine (Pfizer-BioNTech) in December 2020. New adverse events have emerged since these vaccines have reached market. Although no clear association between messenger ribonucleic acid (mRNA) vaccines and autoimmunity has emerged, the significance of such an association warrants further exploration. After obtaining consent, a standardized survey on baseline characteristics and other relevant variables was conducted on unvaccinated individuals who were scheduled for vaccination and had not previously contracted COVID-19. Blood samples were collected from participants prior to the first dose, prior to the second dose, and 1 month after the second dose. All collected samples were tested for antinuclear antibody (ANA) titers using indirect immunofluorescence microscopy kits, and antiphospholipid (APS) immunoglobulin M (IgM) and immunoglobulin G (IgG) levels using an enzyme-linked immunoassay (ELISA) technique. ANA titers were positive for 9 participants out of 101 (8.9%) in the first pre-vaccination draw. For the second draw, the number of participants testing positive for ANA decreased to 5 (5%). For the last draw, 6 (5.9%) participants tested positive for ANA titers. One participant tested positive for APS IgM at the first pre-vaccination draw, 2 tested positive at the second draw, and 2 at the third draw. As for APS IgG titers, all participants tested negative in the three draws. McNemar's test for two dependent categorical outcomes was conducted on all variables and did not show a statistical significance. The McNemar test of these two composite variables (i.e., ANA/APS, first draw vs. ANA/APS, second and third draws) did not show statistical significance. The 2-sided exact significance of the McNemar test was 1.0. The Friedman test also showed no significance (p = 0.459). No association was found between BNT162b2 vaccine administration and changes in APS and ANA titers. The benefits of the BNT162b2 vaccine significantly outweigh any possible risk of autoimmune dysregulation considering the current evidence.
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Affiliation(s)
- Hussein A Noureldine
- LAU Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Julian Maamari
- LAU Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, MN, USA
| | - Mohamad Othman El Helou
- LAU Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
- Scholars in Health Research Program, Faculty of Medicine and Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Georges Chedid
- LAU Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Anna Farra
- LAU Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
- Division of Infectious Diseases, Department of Internal Medicine, Lebanese American University Medical Center - Rizk Hospital, Zahar St, Achrafieh, Beirut, Lebanon
| | - Roula Husni
- LAU Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
- Division of Infectious Diseases, Department of Internal Medicine, Lebanese American University Medical Center - Rizk Hospital, Zahar St, Achrafieh, Beirut, Lebanon
| | - Jacques E Mokhbat
- LAU Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon.
- Division of Infectious Diseases, Department of Internal Medicine, Lebanese American University Medical Center - Rizk Hospital, Zahar St, Achrafieh, Beirut, Lebanon.
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11
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Shimizu S, Sato K, Ito K, Kita A, Aihara K, Tateyama Y, Abe T, Shibasaki M, Yamazaki S, Fukai Y, Iizuka K, Takizawa D, Arai H, Ide M, Uraoka T. A case of possible drug-induced liver injury due to COVID-19 vaccine. KANZO 2022; 63:530-537. [DOI: 10.2957/kanzo.63.530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2024]
Affiliation(s)
- Soichiro Shimizu
- Department of Gastroenterology and Hepatology, Japanese Red Cross Maebashi Hospital
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine
| | - Ken Sato
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine
| | - Kenta Ito
- Department of Gastroenterology and Hepatology, Japanese Red Cross Maebashi Hospital
| | - Aoi Kita
- Department of Gastroenterology and Hepatology, Japanese Red Cross Maebashi Hospital
| | - Kousuke Aihara
- Department of Gastroenterology and Hepatology, Japanese Red Cross Maebashi Hospital
| | - Yumeo Tateyama
- Department of Gastroenterology and Hepatology, Japanese Red Cross Maebashi Hospital
| | - Takahiro Abe
- Department of Gastroenterology and Hepatology, Japanese Red Cross Maebashi Hospital
| | - Mitsuhiko Shibasaki
- Department of Gastroenterology and Hepatology, Japanese Red Cross Maebashi Hospital
| | - Setsuo Yamazaki
- Department of Gastroenterology and Hepatology, Japanese Red Cross Maebashi Hospital
| | - Yasumori Fukai
- Department of Gastroenterology and Hepatology, Japanese Red Cross Maebashi Hospital
| | - Kenichi Iizuka
- Department of Gastroenterology and Hepatology, Japanese Red Cross Maebashi Hospital
| | - Daichi Takizawa
- Department of Gastroenterology and Hepatology, Japanese Red Cross Maebashi Hospital
| | - Hirotaka Arai
- Department of Gastroenterology and Hepatology, Japanese Red Cross Maebashi Hospital
| | - Munenori Ide
- Department of Pathology Diagnosis, Japanese Red Cross Maebashi Hospital
| | - Toshio Uraoka
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine
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12
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Zheng H, Zhang T, Xu Y, Lu X, Sang X. Autoimmune hepatitis after COVID-19 vaccination. Front Immunol 2022; 13:1035073. [PMID: 36505482 PMCID: PMC9732229 DOI: 10.3389/fimmu.2022.1035073] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 11/04/2022] [Indexed: 11/27/2022] Open
Abstract
Vaccination is one of the most vigorous ways to intervene in the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Cases of autoimmune hepatitis (AIH) after coronavirus disease (COVID-19) vaccination have been increasingly reported. Twenty-seven cases of AIH are summarized in this study, providing emerging evidence of autoimmune reactions in response to various COVID-19 vaccines, including in patients with special disease backgrounds such as primary sclerosing cholangitis (PSC), liver transplantation, and previous hepatitis C virus (HCV) treatment. Molecular mimicry, adjuvants, epitope spreading, bystander activation, X chromosome, and sceptical hepatotropism of SARS-CoV-2 may account for, to some extent, such autoimmune phenomena. Immunosuppressive corticosteroids perform well with or without azathioprine in such post-COVID-19-vaccination AIH. However, determination of the exact mechanism and establishment of causality require further confirmation.
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13
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Alhumaid S, Al Mutair A, Rabaan AA, ALShakhs FM, Choudhary OP, Yong SJ, Nainu F, Khan A, Muhammad J, Alhelal F, Al Khamees MH, Alsouaib HA, Al Majhad AS, Al-Tarfi HR, ALyasin AH, Alatiyyah YY, Alsultan AA, Alessa ME, Alessa ME, Alissa MA, Alsayegh EH, Alshakhs HN, Al Samaeel HA, AlShayeb RA, Alnami DA, Alhassan HA, Alabdullah AA, Alhmed AH, AlDera FH, Hajissa K, Al-Tawfiq JA, Al-Omari A. New-onset and relapsed liver diseases following COVID-19 vaccination: a systematic review. BMC Gastroenterol 2022; 22:433. [PMID: 36229799 PMCID: PMC9559550 DOI: 10.1186/s12876-022-02507-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 09/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Liver diseases post-COVID-19 vaccination is extremely rare but can occur. A growing body of evidence has indicated that portal vein thrombosis, autoimmune hepatitis, raised liver enzymes and liver injuries, etc., may be potential consequence of COVID-19 vaccines. OBJECTIVES To describe the results of a systematic review for new-onset and relapsed liver disease following COVID-19 vaccination. METHODS For this systematic review, we searched Proquest, Medline, Embase, PubMed, CINAHL, Wiley online library, Scopus and Nature through the Preferred Reporting Items for Systematic Reviews and Meta Analyses PRISMA guideline for studies on the incidence of new onset or relapsed liver diseases post-COVID-19 vaccination, published from December 1, 2020 to July 31, 2022, with English language restriction. RESULTS Two hundred seventy-five cases from one hundred and eighteen articles were included in the qualitative synthesis of this systematic review. Autoimmune hepatitis (138 cases) was the most frequent pathology observed post-COVID-19 vaccination, followed by portal vein thrombosis (52 cases), raised liver enzymes (26 cases) and liver injury (21 cases). Other cases include splanchnic vein thrombosis, acute cellular rejection of the liver, jaundice, hepatomegaly, acute hepatic failure and hepatic porphyria. Mortality was reported in any of the included cases for acute hepatic failure (n = 4, 50%), portal vein thrombosis (n = 25, 48.1%), splanchnic vein thrombosis (n = 6, 42.8%), jaundice (n = 1, 12.5%), raised liver enzymes (n = 2, 7.7%), and autoimmune hepatitis (n = 3, 2.2%). Most patients were easily treated without any serious complications, recovered and did not require long-term hepatic therapy. CONCLUSION Reported evidence of liver diseases post-COIVD-19 vaccination should not discourage vaccination against this worldwide pandemic. The number of reported cases is relatively very small in relation to the hundreds of millions of vaccinations that have occurred and the protective benefits offered by COVID-19 vaccination far outweigh the risks.
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Affiliation(s)
- Saad Alhumaid
- Administration of Pharmaceutical Care, Al-Ahsa Health Cluster, Ministry of Health, Rashdiah Street, P. O. Box 12944, Al-Ahsa, 31982, Saudi Arabia.
| | - Abbas Al Mutair
- Research Center, Almoosa Specialist Hospital, Al-Ahsa, Saudi Arabia.,College of Nursing, Princess Norah Bint Abdul Rahman University, Riyadh, Saudi Arabia.,School of Nursing, University of Wollongong, Wollongong, Australia
| | - Ali A Rabaan
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.,College of Medicine, Alfaisal University, Riyadh, 11533, Saudi Arabia.,Department of Public Health and Nutrition, The University of Haripur, Haripur, Pakistan
| | - Fatemah M ALShakhs
- Respiratory Therapy Department, Prince Saud Bin Jalawi Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Om Prakash Choudhary
- Department of Veterinary Anatomy and Histology, College of Veterinary Sciences and Animal Husbandry, Central Agricultural University (I), Selesih, Aizawl, Mizoram, 796015, India
| | - Shin Jie Yong
- Department of Biological Sciences, School of Medical and Life Sciences, Sunway University, Subang Jaya, Malaysia
| | - Firzan Nainu
- Department of Pharmacy, Faculty of Pharmacy, Hasanuddin University, Makassar, 90245, Indonesia
| | - Amjad Khan
- Department of Public Health and Nutrition, The University of Haripur, Haripur, Pakistan
| | - Javed Muhammad
- Department of Microbiology, The University of Haripur, Haripur, 22620, Khyber Pakhtunkhwa, Pakistan
| | - Fadil Alhelal
- Optometry Department, Dhahran Eye Specialist Hospital, Ministry of Health, Dhahran, Saudi Arabia
| | | | - Hussain Ahmed Alsouaib
- Medical Store Department, Maternity and Children Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Ahmed Salman Al Majhad
- Medical Store Department, Maternity and Children Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Hassan Redha Al-Tarfi
- Medical Store Department, Maternity and Children Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Ali Hussain ALyasin
- Medical Store Department, Maternity and Children Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | | | - Ali Ahmed Alsultan
- Medical Supply Store, Aloyoon General Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Mohammed Essa Alessa
- Inventory Control Unit, Aloyoon General Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Mustafa Essa Alessa
- Pharmacy Department, Aloyoon General Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Mohammed Ahmed Alissa
- Pharmacy Department, Aloyoon General Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Emad Hassan Alsayegh
- Pharmacy Department, Aloyoon General Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Hassan N Alshakhs
- Pharmacy Department, Aloyoon General Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | | | - Rugayah Ahmed AlShayeb
- Pharmacy Department, King Fahad Hofuf Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Dalal Ahmed Alnami
- Pharmacy Department, King Fahad Hofuf Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Hussain Ali Alhassan
- Pharmacy Department, Maternity and Children Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | | | - Ayat Hussain Alhmed
- Administration of Nursing Care, Maternity and Children Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Faisal Hussain AlDera
- General Surgery Department, King Fahad Hofuf Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Khalid Hajissa
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Jaffar A Al-Tawfiq
- Infectious Disease Unit, Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.,Infectious Disease Division, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.,Infectious Disease Division, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Awad Al-Omari
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.,Research Center, Dr. Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia
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14
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Lasagna A, Lenti MV, Cassaniti I, Sacchi P. Development of hepatitis triggered by SARS-CoV-2 vaccination in patient with cancer during immunotherapy: a case report. Immunotherapy 2022; 14:915-925. [PMID: 35694999 PMCID: PMC9196259 DOI: 10.2217/imt-2021-0342] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 05/12/2022] [Indexed: 12/18/2022] Open
Abstract
Patients with cancer have a higher risk of severe COVID-19, and expert consensus advocates for COVID-19 vaccination in this population. Some cases of autoimmune hepatitis have been described after the administration of COVID-19 vaccine in the people in apparently good health. Immune checkpoint inhibitors (ICIs) are responsible for a wide spectrum of immune-related adverse events (irAEs). This article reports a case of hepatitis and colitis in a 52-year-old woman who was undergoing immunotherapy and was HBV positive 10 days after receiving the first Pfizer-BioNTech COVID-19 vaccine dose. Because both ICIs and the COVID-19 vaccines stimulate the immune response, the authors hypothesize that these vaccines may increase the incidence of irAEs during ICI treatment. There is a complex interplay between the immune-mediated reaction triggered by the vaccination and PD-L1 co-administration.
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Affiliation(s)
- Angioletta Lasagna
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, 27100, Italy
| | - Marco Vincenzo Lenti
- Department of Internal Medicine, Clinica Medica, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, 27100, Italy
| | - Irene Cassaniti
- Department of Microbiology & Virology, Molecular Virology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, 27100, Italy
| | - Paolo Sacchi
- Division of Infectious Diseases I, Fondazione IRCCS Policlinico San Matteo, Pavia, 27100, Italy
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15
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Izagirre A, Arzallus T, Garmendia M, Torrente S, Castiella A, Zapata EM. Autoimmune hepatitis following COVID-19 vaccination. J Autoimmun 2022; 132:102874. [PMID: 35985054 PMCID: PMC9353598 DOI: 10.1016/j.jaut.2022.102874] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/16/2022] [Accepted: 07/16/2022] [Indexed: 11/25/2022]
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16
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Lleo A, Cazzagon N, Rigamonti C, Cabibbo G, Lai Q, Muratori L, Carbone M. Clinical update on risks and efficacy of anti-SARS-CoV-2 vaccines in patients with autoimmune hepatitis and summary of reports on post-vaccination liver injury. Dig Liver Dis 2022; 54:722-726. [PMID: 35410851 PMCID: PMC8958090 DOI: 10.1016/j.dld.2022.03.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/18/2022] [Accepted: 03/21/2022] [Indexed: 12/12/2022]
Abstract
Patients with liver diseases, especially those with cirrhosis, have an increased mortality risk when infected by SARS-CoV-2 and therefore anti-SARS-CoV-2 vaccine has been recommended by leading Scientific Associations for all patients with chronic liver diseases. However, previous reports have shown a reduced antibody response following the full course of vaccination in immunosuppressed patients, including liver transplant recipients and several rheumatic diseases. This document, drafted by an expert panel of hepatologists appointed by the Italian Association for the Study of the Liver (AISF), aims to present the updated scientific data on the safety and efficacy of anti-SARS-CoV-2 mRNA vaccines in patients with autoimmune hepatitis (AIH). Furthermore, given the recent reports of sporadic cases of AIH-like cases following anti-SARS-CoV-2 mRNA vaccines, we summarize available data. Finally, we provide experts recommendations based on the limited data available.
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Affiliation(s)
- Ana Lleo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Internal Medicine and Hepatology Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
| | - Nora Cazzagon
- Gastroenterology Unit, Department of Surgery, Oncology, and Gastroenterology, University of Padova, Padova, Italy
| | - Cristina Rigamonti
- Department of Translational Medicine, Università del Piemonte Orientale and Division of Internal Medicine, Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
| | - Giuseppe Cabibbo
- Section of Gastroenterology and Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, Palermo, Italy
| | - Quirino Lai
- Unità di Chirurgia Generale e Trapianti d'Organo, Dipartimento di Chirurgia Generale e Specialistica, Sapienza Università di Roma, Azienda Ospedaliero-Universitaria Policlinico Umberto I di Roma, Italy
| | - Luigi Muratori
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Center for the Study and Treatment of Autoimmune Diseases of the Liver and Biliary System, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Marco Carbone
- Division of Gastroenterology, Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
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17
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Sergi CM. Acute Hepatitis of Unknown Origin (AHUO)-The Puzzle Ahead. Diagnostics (Basel) 2022; 12:diagnostics12051215. [PMID: 35626370 PMCID: PMC9140145 DOI: 10.3390/diagnostics12051215] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 05/10/2022] [Indexed: 02/06/2023] Open
Abstract
An intriguing form of hepatitis has been detected in more than a hundred children worldwide [...].
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Affiliation(s)
- Consolato M Sergi
- Division of Anatomic Pathology, Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
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18
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Jena A, Aggarwal T, Mitra S, Singh AK. Nintedanib-induced liver injury: Not every liver injury is virus or vaccine-induced in the era of COVID-19. Liver Int 2022; 42:1210-1211. [PMID: 35195327 DOI: 10.1111/liv.15206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 02/14/2022] [Accepted: 02/18/2022] [Indexed: 02/13/2023]
Affiliation(s)
- Anuraag Jena
- Department of Gastroenterology, PGIMER, Chandigarh, India
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19
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Elasomeran. REACTIONS WEEKLY 2022. [PMCID: PMC8831156 DOI: 10.1007/s40278-022-09916-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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20
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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; 67:4574-4580. [PMID: 35486203 PMCID: PMC9052185 DOI: 10.1007/s10620-022-07504-w] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/15/2022] [Indexed: 12/19/2022]
Abstract
OBJECTIVES During the summer of 2021, case reports began to emerge documenting a small number of individuals who developed autoimmune hepatitis (AIH) following COVID-19 vaccination. These cases are rare and novel, and very little is known. In our systematic review, we analyzed every published case of AIH and reviewed their characteristic findings, treatment, and outcomes. METHODS We searched PubMed, Embase, and Web of Science from December 1, 2019, to November 1, 2021. Two researchers independently extracted information from the articles about vaccine type, patient history, laboratory values, histology results, treatment regimens, and disease course. RESULTS Thirty-two patients developed AIH-like syndromes after receiving a COVID-19 vaccine. Jaundice was the most frequently reported symptom (81%), and 19% of patients were initially asymptomatic and presented with elevated liver enzymes found during routine bloodwork. Mean alanine transaminase, aspartate transaminase, and total bilirubin were 1231 U/L, 921 U/L, and 14 mg/dL, respectively. Anti-nuclear antibody was positive in 56%, and anti-smooth muscle antibody in 28% of patients. Steroids were used in 75% of patients. Improvement or complete resolution was seen in 97% of patients. One patient died despite aggressive steroid treatment. CONCLUSION COVID-19 vaccine-induced AIH is an uncommon association with just 32 documented cases in the literature. Clinicians should be vigilant for AIH in patients who present with liver injury following vaccination. These new findings should under not deter individuals from getting vaccinated, as the benefits of vaccination far outweigh the risks. Fortunately, COVID-19 vaccine-induced AIH appears amendable to corticosteroid therapy and appears to have a favorable outcome.
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Affiliation(s)
- Kenneth W. Chow
- Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA USA
| | - Nguyen V. Pham
- Departments of Surgery, UCLA Medical Center, Pfleger Liver Institute, University of California at Los Angeles, 200 Medical Plaza, Suite 214, Los Angeles, CA 90095 USA
| | - Britney M. Ibrahim
- Departments of Surgery, UCLA Medical Center, Pfleger Liver Institute, University of California at Los Angeles, 200 Medical Plaza, Suite 214, Los Angeles, CA 90095 USA
| | - Kimberly Hong
- Departments of Surgery, UCLA Medical Center, Pfleger Liver Institute, University of California at Los Angeles, 200 Medical Plaza, Suite 214, Los Angeles, CA 90095 USA
| | - Sammy Saab
- Departments of Surgery, UCLA Medical Center, Pfleger Liver Institute, University of California at Los Angeles, 200 Medical Plaza, Suite 214, Los Angeles, CA 90095 USA ,Departments of Medicine, UCLA Medical Center, Pfleger Liver Institute, University of California at Los Angeles, 200 Medical Plaza, Suite 214, Los Angeles, CA 90095 USA
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