Subject(s)
COVID-19/diagnosis , Jaundice/etiology , Liver/pathology , Systemic Inflammatory Response Syndrome/diagnosis , Bone Marrow/pathology , C-Reactive Protein/analysis , COVID-19/complications , Cholestasis/diagnosis , Diagnosis, Differential , Humans , Male , Middle Aged , Pruritus/etiology , Systemic Inflammatory Response Syndrome/complicationsSubject(s)
COVID-19 Vaccines/adverse effects , Carcinoma, Non-Small-Cell Lung/drug therapy , Hemolysis , Jaundice/etiology , Lung Neoplasms/drug therapy , Vicia faba/adverse effects , Aged , Antibodies, Monoclonal/therapeutic use , Blood Transfusion , Carcinoma, Non-Small-Cell Lung/blood , Carcinoma, Non-Small-Cell Lung/complications , Diagnosis, Differential , Glucosephosphate Dehydrogenase Deficiency/complications , Humans , Lung Neoplasms/blood , Lung Neoplasms/complications , Male , Vaccination/adverse effectsABSTRACT
The COVID-19 pandemic is still raging across the world and vaccination is expected to lead us out of this pandemic. Although the efficacy of the vaccines is beyond doubt, safety still remains a concern. We report a case of a 65-year-old woman who experienced acute severe autoimmune hepatitis two weeks after receiving the first dose of Moderna-COVID-19 vaccine. Serum immunoglobulin G was elevated and antinuclear antibody was positive (1:100, speckled pattern). Liver histology showed a marked expansion of the portal tracts, severe interface hepatitis and multiple confluent foci of lobular necrosis. She started treatment with prednisolone, with a favorable clinical and analytical evolution. Some recent reports have been suggested that COVID-19 vaccination can lead to the development of autoimmune diseases. It is speculated that the vaccine can disturb self-tolerance and trigger autoimmune responses through cross-reactivity with host cells. Therefore, healthcare providers must remain vigilant during mass COVID-19 vaccination.
Subject(s)
BNT162 Vaccine/adverse effects , COVID-19/prevention & control , Hepatitis, Autoimmune/etiology , Jaundice/etiology , Vaccination/adverse effects , Antibodies, Antinuclear/blood , BNT162 Vaccine/immunology , Bilirubin/blood , Female , Fibrosis/pathology , Hepatitis, Autoimmune/immunology , Humans , Jaundice/diagnosis , Liver/enzymology , Middle Aged , Molecular Mimicry/immunology , Prednisolone/therapeutic use , SARS-CoV-2/immunologySubject(s)
COVID-19 , Jaundice , Thrombocytopenia , COVID-19 Vaccines , Humans , Jaundice/diagnosis , Jaundice/etiology , Liver , SARS-CoV-2 , Thrombocytopenia/diagnosisABSTRACT
Unprecedented loss of life due to the COVID pandemic has necessitated the development of several vaccines in record time. Most of these vaccines have received approval without being extensively whetted for their adverse effect and efficacy profiles. Most adverse effects have been mild, nonetheless, more serious thromboembolic events have also been reported. Autoimmune hepatitis (AIH) can occur in predisposed individuals where an immune mediated reaction against hepatocytes is triggered by environmental factors. Vaccines are a very rare cause of AIH. We report two such cases of AIH triggered by COVID (Covishield) vaccination. While one patient made an uneventful recovery, another succumbed to the liver disease. Ours is the first report of Covishield vaccination related AIH and second ever after any form of COVID vaccination. We hope that our report does not deter COVID vaccination drives. However, we also hope to raise awareness of its potential side effects and the increased role of pharmacovigilance in guiding treatment.
Subject(s)
COVID-19 Vaccines/adverse effects , COVID-19/prevention & control , Hepatitis, Autoimmune/etiology , Pandemics , SARS-CoV-2/immunology , Vaccination/adverse effects , Adult , ChAdOx1 nCoV-19 , Fatal Outcome , Female , Hepatitis B, Chronic/complications , Hepatitis, Autoimmune/immunology , Hepatitis, Autoimmune/pathology , Humans , Hypothyroidism/complications , Jaundice/etiology , Male , Middle Aged , Models, Immunological , PharmacovigilanceSubject(s)
Anemia, Hemolytic, Autoimmune/etiology , Anemia, Hemolytic, Autoimmune/therapy , BNT162 Vaccine/adverse effects , COVID-19/immunology , Anemia, Hemolytic, Autoimmune/diagnosis , Anemia, Hemolytic, Autoimmune/immunology , BNT162 Vaccine/administration & dosage , Blood Transfusion/methods , COVID-19/diagnosis , COVID-19/prevention & control , COVID-19/virology , Combined Modality Therapy , Coombs Test/methods , Dyspnea/etiology , Fatigue/etiology , Female , Humans , Immunologic Factors/therapeutic use , Jaundice/etiology , Middle Aged , Pallor/etiology , Rituximab/therapeutic use , SARS-CoV-2/genetics , SARS-CoV-2/immunology , Tachycardia/etiology , Treatment OutcomeABSTRACT
A 52 year old previously healthy woman from Mumbai presented with fever and jaundice of 10 days duration. At admission, she was jaundiced with tachycardia, tachypnea, hypoxia, hypotension, conjunctival congestion and mild erythematous flush over the skin. She had very high WBC counts and CRP's with direct hyperbilirubinemia and azotemia. Investigations for infectious causes of fever were negative. RT-PCR for SARS-CoV-2 in the nasopharynx was negative. However her SARS-CoV-2 antibodies were reactive. She also had echocardiographic and biochemical evidence of cardiac dysfunction. The diagnosis of Multisystem inflammatory syndrome-Adult (MIS-A) was thus established. She rapidly improved with intravenous immunoglobulin (2â¯gm/kg) and high dose steroids.
Subject(s)
Fever/etiology , Jaundice/etiology , Azotemia/drug therapy , Azotemia/metabolism , Azotemia/microbiology , COVID-19/microbiology , Echocardiography , Fever/drug therapy , Fever/metabolism , Humans , Hyperbilirubinemia/drug therapy , Hyperbilirubinemia/metabolism , Hyperbilirubinemia/microbiology , Immunoglobulins/therapeutic use , Jaundice/drug therapy , Jaundice/metabolism , Reverse Transcriptase Polymerase Chain Reaction , SARS-CoV-2/drug effects , SARS-CoV-2/pathogenicity , Steroids/metabolismABSTRACT
A man in his early 50s presented with jaundice, mild shortness of breath on exertion and dark urine. He had had coryzal symptoms 2 weeks prior to admission. Medical history included obstructive sleep apnoea and hypertension. His initial blood tests showed a mild hyperbilirubinaemia and acute kidney injury stage 1. Chest X-ray and CT pulmonary angiogram were negative for features suggestive of COVID-19. He later developed a drop in haemoglobin and repeat bloods showed markedly raised lactate dehydrogenase and positive direct antiglobulin test. These results were felt to be consistent with a haemolytic anaemia. A nasopharyngeal swab came back positive for COVID-19. We suspect the cause of his symptoms was an autoimmune haemolytic anaemia secondary to COVID-19 which has recently been described in European cohorts.
Subject(s)
Anemia, Hemolytic, Autoimmune/diagnosis , Anemia, Hemolytic, Autoimmune/etiology , COVID-19 Testing , COVID-19/diagnosis , COVID-19/complications , Chest Pain/etiology , Hemoglobinuria/etiology , Humans , Jaundice/etiology , Male , Middle AgedABSTRACT
This article reports an incidental finding of leptospirosis during a special consultation, which was initiated due to the pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The focus on SARS-CoV2 and the uncharacteristic symptoms of these two diseases make it much more difficult to find the correct diagnosis. Leptospirosis is predominantly a tropical zoonosis but also occurs in Germany.