Sex: F
Vaccine: YF
Symptoms: Biopsy liver abnormal, Blood albumin decreased, Blood alkaline phosphatase increased, Blood bilirubin increased, Computerised tomogram abdomen normal
Clinical narrative: seronegative autoimmune hepatitis; right upper quadrant (RUQ) abdominal pain; jaundice; intermittent low grade fever; Initial unsolicited report received from the literature on 18-Oct-2019.  Literature citation-  The following is the abstract from the article-  Acute seronegative autoimmune hepatitis is a rare entity but has been reported in the literature. Few cases have been reported where hepatitis occured after yellow fever vaccine. We present a case of acute seronegative autoimmune hepatitis (SAIH) that has probable association with yellow fever vaccine as indicated by the patient's strong history.  This case involves a 35 years old female patient who experienced seronegative autoimmune hepatitis (autoimmune hepatitis), while she received vaccine YELLOW FEVER VACCINE.  The patient's past vaccination(s) included yellow fever vaccine. The patient's past medical history, medical treatment(s) and family history were not provided.  On an unknown date, the patient received a dose of suspect YELLOW FEVER VACCINE produced by unknown manufacturer lot number not reported via unknown route in unknown administration site.  On an unknown date, the patient developed a serious right upper quadrant (RUQ) abdominal pain (abdominal pain upper), seronegative autoimmune hepatitis (autoimmune hepatitis), (Unknown latency) following the administration of YELLOW FEVER VACCINE. This event was assessed as medically significant. The patient was hospitalized for this event.  On an unknown date, the patient developed a serious jaundice and intermittent low grade fever (pyrexia) (Unknown latency) following the administration of YELLOW FEVER VACCINE. The patient was hospitalized for this event.  On an unknown date, the patient was discharge from the hospital.  Relevant laboratory test results included: Alanine aminotransferase - On an unknown date: 2189 [2189]; on an unknown date: 1146 [1146]; on an unknown date: 603 [603]; on an unknown date: 78 [78] Aspartate aminotransferase - On an unknown date: 2135 [2135]; on an unknown date: 1087 [1087]; on an unknown date: 374 [374]; on an unknown date: 67 [67] Bilirubin conjugated abnormal - On an unknown date: 1.8 [1.8]; on an unknown date: 12.5 [12.5]; on an unknown date: 10.2 Blood albumin - On an unknown date: 3.6 [3.6]; on an unknown date: 2.7 [2.7] Blood alkaline phosphatase - On an unknown date: 213 [213]; on an unknown date: 132 [132]; on an unknown date: 83 [83] Blood bilirubin - On an unknown date: 2.5 [2.5]; on an unknown date: 20.7 [20.7]; on an unknown date: 19.1; on an unknown date: 3.6 [3.6] International normalised ratio - On an unknown date: 1.3 [1.3] Platelet count - On an unknown date: 13.2 [13.2] Protein total - On an unknown date: 7.9 [7.9]; on an unknown date: 7 [7]  (Other relevant tests included CT abdomen was unremarkable for biliary system abnormalities Her viral panel (HSV, EBV, HIV, Hepatitis A-D serology) and autoimmune work-up (ANA, anti DNA, anti smooth muscle, anti mitochondrial, SSA, SSB antibodies turned) were negative. PCR for Yellow fever virus was negative as well. Liver biopsy showed severe chronic active hepatitis (grade III) without fibrosis (grade 0) but with extensive periportal necroinflammatory changes, hence, a working diagnosis of SAIH was made.)  Final diagnosis was Mild seronegative autoimmune hepatitis  The patient was treated with 1 gm METHYLPREDNISOLONE SODIUM SUCCINATE (SOLUMEDROL) and PREDNISONE (PREDNISONE) 40 mg daily. They were able to taper her steroids in the next 4 months with maintenance treatment of 5mg Prednisone.  The outcome of the event was Unknown for all the events.  Conclusion: It is concluded that given the history of this patient, the possibility of association of yellow fever vaccine inducing acute flare of autoimmune hepatitis cannot be ruled out. Further studies to unearth this rare association in detail are warranted.  Information on the batch number was requested.; Sender's Comments: This literature article concerns 35 years old female patient who experienced autoimmune hepatitis, abdominal pain upper, jaundice and pyrexia after vaccination with YELLOW FEVER VACCINE produced by unknown manufacturer. The time to onset is unknown. Lab data provided. Additional information regarding patient's past medical history, condition at the time of vaccination, other predisposing etiologies would be needed for complete assessment of the case. Based upon the reported information, the role of the vaccine cannot be assessed.