key: cord-0914700-c3eo70d7
authors: Fimiano, Federica; D’Amato, Daphne; Gambella, Alessandro; Marzano, Alfredo; Saracco, Giorgio M.; Morgando, Anna
title: Autoimmune hepatitis or drug‐induced autoimmune hepatitis following Covid‐19 vaccination?
date: 2022-03-11
journal: Liver Int
DOI: 10.1111/liv.15224
sha: ad1ea7c765f31021db3cd9908a919b69f4f9692d
doc_id: 914700
cord_uid: c3eo70d7

nan

Several cases of autoimmune hepatitis (AIH) after coronavirus disease 2019 (Covid-19) vaccination have been recently reported. [1] [2] [3] [4] However, no data to prove a casual relation between vaccine and AIH is still available. More recently, a case of acute immune-mediated hepatitis after severe acute respiratory syndrome (Sars Cov-2) Moderna Vaccine has been reported. 5 This is a hot topic since these vaccines are very recent, the worldwide population is going to be vaccinated, and Notably, the antibodies anti-Sars-CoV 2 spike protein was higher than 35 000 BAU/ml, more than 1000 times the upper normal level (UNL).

During the hospitalization, because of bilirubin and transaminases levels were stably increased, the autoimmunity was negative and the IgG title was mildly upper of normal she underwent liver biopsy on 15

September. Histology demonstrated severe acute hepatitis with an intense portal/periportal and lobular plasma cell-rich inflammation, interface activity and focal confluent necrosis. Centrilobular congestion, hepatocellular ballooning and scattered apoptotic bodies were also observed ( Figure 1 ). Confirming the AIH-like features, methylprednisolone at 1 mg/kg/daily was started; after that, a slow but constant reduction of transaminases and bilirubin was observed. Azathioprine 50 mg daily was imbricated, obtaining a further improvement of the liver tests.

Notably, the latency period between the vaccination and the hospitalization is longer compared to other cases previously reported. [1] [2] [3] [4] Though, the onset of AIH may have been earlier and subclinical, therefore, diagnosed only when needing medical attention.

Moreover, there are no confounding factors (such as other medication, toxics or pregnancy) regarding the medical history of the hereby presented patient.

As known, AIH could be triggered by some viruses, including COVID 19, 6 by vaccination 7 and by drugs 8 and liver injury can be toxic through a direct or immunomodulated mechanism. In the latter case, we talk about drug-induced autoimmune hepatitis (DI-AIH) that is different from classic AIH because of no recurrence after glu- 

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