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J Autoimmun ; 123: 102710, 2021 09.
Article in English | MEDLINE | ID: covidwho-1330939


The development of autoimmune diseases has been reported after SARS-CoV-2 infection. Vaccination against SARS-CoV-2 could also trigger auto-immunity, as it has been described with other vaccines. An aberrant immune response induced by molecular mimicry and bystander activation, especially in predisposed individuals, is a potential mechanism. We report the case of a 76-year-old woman with Hashimoto thyroiditis and prior COVID-19 infection who developed severe autoimmune hepatitis (with typical features including strongly positive anti-smooth muscle antibody and markedly elevated immunoglobulins G, as well as typical histological findings) following SARS-CoV-2 vaccination (mRNA-1273 SARS-CoV-2 vaccine, Moderna®). The link between SARS-CoV-2 vaccination and the development of autoimmune diseases needs to be further investigated. Although a causality relationship cannot be proven, caution may be warranted when vaccinating individuals with known autoimmune diseases.

Autoantibodies/immunology , COVID-19 Vaccines/adverse effects , COVID-19/prevention & control , Hepatitis, Autoimmune/etiology , SARS-CoV-2/immunology , Vaccination/adverse effects , Aged , Azathioprine/therapeutic use , Carcinoma, Transitional Cell/complications , Causality , Disease Susceptibility , Female , Hashimoto Disease/complications , Hepatitis, Autoimmune/drug therapy , Hepatitis, Autoimmune/immunology , Hepatitis, Autoimmune/pathology , Hepatitis, Chronic/complications , Hepatitis, Chronic/pathology , Humans , Immunocompromised Host , Immunosuppressive Agents/therapeutic use , Prednisolone/therapeutic use , Urinary Bladder Neoplasms/complications
J Autoimmun ; 123: 102706, 2021 09.
Article in English | MEDLINE | ID: covidwho-1309270


Autoimmune phenomena and clinically apparent autoimmune diseases, including autoimmune hepatitis, are increasingly been reported not only after natural infection with the SARS-CoV-2 virus, but also after vaccination against it. We report the case of a 63-year old man without a history of autoimmunity or SARS-CoV-2 natural infection who experienced acute severe autoimmune-like hepatitis seven days after the first dose of the mRNA-1273 SARS-CoV-2 vaccine. Liver histology showed inflammatory portal infiltrate with interface hepatitis, lobular and centrilobular inflammation with centrilobular necrosis, in absence of fibrosis and steatosis. Serum immunoglobulin G was slightly elevated. Autoimmune liver serology showed an indirect immunofluorescence pattern on triple rodent tissue compatible with anti-mitochondrial antibody (AMA), but, unexpectedly, this pattern was not mirrored by positivity for primary biliary cholangitis (PBC)-specific molecular tests, indicating that this antibody is different from classical AMA. Anti-nuclear antibody (ANA) was also positive with a rim-like indirect immunofluorescence pattern on liver and HEp2 cell substrates, similar to PBC-specific ANA; however, anti-gp210 and a large panel of molecular-based assays for nuclear antigens were negative, suggesting a unique ANA in our patient. He carries the HLA DRB1*11:01 allele, which is protective against PBC. Response to prednisone treatment was satisfactory. The clinical significance of these novel specificities needs to be further evaluated in this emerging condition.

Autoantibodies/immunology , COVID-19 Vaccines/adverse effects , COVID-19/prevention & control , HLA-DRB1 Chains/immunology , Hepatitis, Autoimmune/etiology , Mitochondria/immunology , SARS-CoV-2/immunology , Vaccination/adverse effects , Animals , Antibodies, Antinuclear/immunology , Antibody Specificity , Autoantigens/immunology , Cell Line , Fluorescent Antibody Technique, Indirect , Hepatitis, Autoimmune/drug therapy , Hepatitis, Autoimmune/immunology , Hepatitis, Autoimmune/pathology , Humans , Immunosuppressive Agents/therapeutic use , Liver/immunology , Liver/pathology , Male , Middle Aged , Prednisone/therapeutic use , Rosuvastatin Calcium/adverse effects , Rosuvastatin Calcium/therapeutic use