Autoimmune hepatitis after COVID-19 vaccination

Area of Science:

• Immunology
• Hepatology
• Vaccinology

Background:

• The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic necessitates robust interventions like vaccination.
• Increasing reports link coronavirus disease (COVID-19) vaccination to new-onset autoimmune hepatitis (AIH).

Purpose of the Study:

• To summarize cases of autoimmune hepatitis (AIH) following COVID-19 vaccination.
• To explore potential mechanisms and treatment outcomes for post-vaccination AIH.

Main Methods:

• A retrospective summary of 27 cases of AIH diagnosed after COVID-19 vaccination.
• Review of patient disease backgrounds, vaccine types, and treatment responses.

Main Results:

• Twenty-seven cases of AIH post-COVID-19 vaccination were identified.
• AIH occurred in patients with diverse backgrounds, including primary sclerosing cholangitis (PSC), liver transplantation, and prior hepatitis C virus (HCV) treatment.
• Corticosteroids, with or without azathioprine, were effective in managing post-vaccination AIH.

Conclusions:

• COVID-19 vaccination is associated with emerging cases of autoimmune hepatitis (AIH).
• Potential mechanisms include molecular mimicry, adjuvants, epitope spreading, bystander activation, X chromosome influence, and SARS-CoV-2 hepatotropism.
• Immunosuppressive therapy demonstrates efficacy in treating post-vaccination AIH, though causality requires further investigation.