Acute autoimmune-like hepatitis with atypical anti-mitochondrial antibody after mRNA COVID-19 vaccination: A novel clinical entity?
J Autoimmun
; 123: 102706, 2021 09.
Article
in English
| MEDLINE | ID: covidwho-1309270
ABSTRACT
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*1101 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.
Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Autoantibodies
/
Vaccination
/
Hepatitis, Autoimmune
/
HLA-DRB1 Chains
/
COVID-19 Vaccines
/
SARS-CoV-2
/
COVID-19
/
Mitochondria
Type of study:
Case report
/
Experimental Studies
/
Observational study
/
Prognostic study
Topics:
Vaccines
Limits:
Animals
/
Humans
/
Male
/
Middle aged
Language:
English
Journal:
J Autoimmun
Journal subject:
Allergy and Immunology
Year:
2021
Document Type:
Article
Affiliation country:
J.jaut.2021.102706
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