Investigating Acute Hepatitis after SARS-CoV-2 Vaccination or Infection: A Genetic Case Series

(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 serie...

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Published in:	Biomedicines Vol. 11; no. 10; p. 2848
Main Authors:	Bernasconi, Elisa, Biagi, Matteo, Di Agostino, Stefania, Cursaro, Carmela, Felicani, Cristina, Ronconi, Enrico, Franchi, Elena, Costanzo, Arianna Carmen, Gabrielli, Filippo, Cavicchioli, Alessia, Ienopoli, Giuseppe, Marenghi, Paolo, Bartoli, Alessandra, Serra, Beatrice, Scalabrini, Davide, Sighinolfi, Pamela, Andreone, Pietro
Format:	Journal Article
Language:	English
Published:	Basel MDPI AG 01-10-2023 MDPI
Subjects:	Abdomen acute hepatitis Antibodies Antigens Asymptomatic autoimmune hepatitis Biopsy Blood tests Complications and side effects Coronaviruses COVID-19 vaccine COVID-19 vaccines Cytomegalovirus Development and progression Diagnosis Disease Disease susceptibility Drb1 protein Drug dosages Enzymes Epstein-Barr virus Genetic aspects genetic background Genetic research Hepatitis A Hepatitis C virus Hepatology Histocompatibility antigen HLA Histology HIV HIV (Viruses) Human immunodeficiency virus Hypertension Infections Laboratories Liver Pathogenesis Patients Pruritus SARS-CoV-2 infection Serology Severe acute respiratory syndrome Severe acute respiratory syndrome coronavirus 2 Tissue typing Ultrasonic imaging Vaccination Vectors (Biology) Viruses Timor-Leste
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Summary:	(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 DRB103,07,13,14), and in three of them, HLA DRB111 was also detected. Two patients developed acute hepatitis without autoimmune hallmarks which resolved spontaneously, both positive for HLA DRB111. (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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 These authors contributed equally to this work.
ISSN:	2227-9059 2227-9059
DOI:	10.3390/biomedicines11102848