Autoimmune hepatitis triggered by SARS-CoV-2 vaccination

Area of Science:

• Immunology
• Vaccinology
• Hepatology

Background:

• Autoimmune diseases have been linked to SARS-CoV-2 infection.
• Vaccination, including against SARS-CoV-2, can potentially trigger autoimmunity, a phenomenon observed with other vaccines.
• Mechanisms like molecular mimicry and bystander activation may underlie vaccine-induced autoimmunity, particularly in susceptible individuals.

Observation:

• A 76-year-old woman with pre-existing Hashimoto thyroiditis and a history of COVID-19 infection received the mRNA-1273 SARS-CoV-2 vaccine (Moderna®).

Findings:

• Following vaccination, the patient developed severe autoimmune hepatitis.
• Diagnostic features included strongly positive anti-smooth muscle antibodies, markedly elevated immunoglobulin G levels, and characteristic histological findings.
• This case suggests a potential association between SARS-CoV-2 vaccination and the onset of autoimmune hepatitis.

Implications:

• The relationship between SARS-CoV-2 vaccination and autoimmune disease development requires further investigation.
• While causality is not definitively proven, caution may be advisable when administering vaccines to individuals with established autoimmune conditions.
• This case highlights the importance of monitoring for autoimmune events post-vaccination in at-risk populations.