Sex: F
Vaccine: COVID19
Symptoms: Bilirubin conjugated, Biopsy liver, Blood alkaline phosphatase, Blood bilirubin, Investigation
Clinical narrative: Acute Autoimmune Hepatitis After COVID-19 Vaccine; This is a literature report for the following literature source(s).  The author presented a rare case of autoimmune hepatitis (AIH) following COVID-19 vaccination, highlighting emerging concerns about vaccine-induced autoimmune diseases. A 57-year-old woman with no significant medical history presented with jaundice and excessive fatigue for 2 weeks. She denied recent travel, medications, or alcohol use but had received a booster dose of the Pfizer COVID-19 vaccine just before the onset of symptoms. Examination showed scleral icterus. Blood work revealed elevated levels of bilirubin, AST, ALT, and ALP. Abdominal ultrasound showed a hepatic echotexture with a "starry sky" appearance, consistent with acute hepatitis. More workup revealed a positive ANA screen with a 1:1280 titer and cytoplasmic pattern. Antimitochondrial antibody was positive. Liver biopsy showed multiple portal tracts expanded by plasma cell-predominant inflammatory infiltrate with severe interface activity. The remaining hepatic parenchyma showed extensive lobular disarray with multiacinar collapse, apoptotic hepatocytes, and ceroid-containing macrophages. Overall, the findings are consistent with acute AIH. She was subsequently given IV methylprednisolone 40 mg daily, resulting in marked improvement (Alanine Aminotransferase (ALT): 21, notes: Day-30; 479, notes: Day 7; 725, notes: Day 4; 805, notes: Day 3 steroid started; 834, notes: Day 2; 950, notes: Day 1; Aspartate Aminotransferase (AST): 16, notes: Day-30; 385, notes: Day 7; 595, notes: Day 4; 830, notes: Day 3 steroid started; 844, notes: Day 2; 903, notes: Day 1; bilirubin direct: 0.4, notes: Day -30; 3.8, notes: Day 7; 8.6, notes: Day-1; Alkaline Phosphatase (ALP): 65, notes: Day-30; 171, notes: Day 7; 216, notes: Day 4; 204, notes: Day 3 steroid started; 210, notes: Day 2; 242, notes: Day 1; bilirubin, total: 1.2, notes: Day-30; 7.0, notes: Day 7; 13.2, notes: Day 4; 13.0, notes: Day 3 steroid started; 11.2, notes: Day 2; 10.7, notes: Day 1). She was discharged with oral steroids and scheduled for hepatology follow-up. Discussion: The presence of ceroid-containing macrophages and lobular disarray/hepatocytic necrosis, along with recent immunization, raises suspicion for drug-induced autoimmune hepatitis. AIH cases following COVID-19 vaccination range from 27 to 82 years of age, mostly in females, and occur after any vaccine dose. The time of symptom onset from vaccination varies from 1 day to 1 month, with jaundice occurring in nearly all cases. Abnormal LFTs are common, but normal results do not exclude AIH. Possible mechanisms include molecular mimicry, adjuvants, epitope spreading, bystander activation, X chromosome factors, and skeptical hepatotropism of SARS-CoV-2. Steroid therapy, with or without azathioprine, shows favorable outcomes. The key question is whether subsequent COVID-19 vaccine doses are safe when immune hepatitis develops post-vaccination.; Sender's Comments: Based on the implied temporal association, a causal relationship between suspect drug and the reported event autoimmune hepatitis cannot be excluded.  The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate.