Hepatitis B virus infection flare induced acute-on-chronic liver failure after COVID-19 vaccination: a case report
Hepatitis Monthly
; 21(12), 2021.
Article
in English
| CAB Abstracts | ID: covidwho-1903804
ABSTRACT
Introduction:
During the coronavirus disease 2019 (COVID-19) pandemic, COVID-19 vaccination is essential for controlling the outbreak and preventing severe disease. However, there are still uncertainties about the safety of COVID-19 vaccination in individuals with chronic liver disease. Case Presentation Three patients with hepatitis B virus (HBV) infection presented to our hospital with acute-on-chronic liver failure (ACLF) due to HBV flare after COVID-19 vaccination (mRNA-1273 and ChAdOx1 nCoV-19). Their COVID-19 antibodies were tested by Elecsys Anti-SARS-CoV-2 S immunoassay, which showed good response after full two-dose course of vaccine. One patient refused the test. The patients' clinical conditions deteriorated during hospitalization. Patient 1 received Entecavir (Baraclude) 1 mg/day upon presentation, but the serum bilirubin level and international normalized ratio (INR) kept increasing. He was comatose in one week and underwent urgent living donor liver transplantation. Patient 2 was on regular Entecavir (Baraclude) 0.5 mg/day and was increased to 1 mg/day upon admission. The serum bilirubin level and INR kept increasing, and he developed grade 3 hepatic encephalopathy in three weeks. The patient then received urgent living donor liver transplantation. Patient 3 received Entecavir (Baraclude) 1 mg/day upon presentation. Her serum bilirubin and INR kept increasing, and her mental status altered in a week. She did not undergo liver transplantation for her old age.Conclusions:
It is not still unclear whether there is a cause-and-effect relationship between COVID-19 vaccination and HBV infection flare. Furthermore, the mechanism of COVID-19 vaccine-induced HBV reactivation is not established. Further studies are needed in this regard. However, during the COVID-19 pandemic, prophylactic antiviral therapy for HBV infection before COVID-19 vaccination should be considered.
Host Resistance and Immunity [HH600]; Prion, Viral, Bacterial and Fungal Pathogens of Humans [VV210]; Non-communicable Human Diseases and Injuries [VV600]; acute course; antiviral agents; bilirubin; blood serum; case reports; clinical aspects; coronavirus disease 2019; disease prevention; drug therapy; encephalopathy; entecavir; hepatitis B; hospital stay; human diseases; immunization; immunoassay; liver; liver failure; liver transplant; mental health; outbreaks; pandemics; patients; prophylaxis; safety; transplantation; vaccination; vaccines; viral diseases; viral hepatitis; severe course; immune sensitization; Hepatitis B virus; man; Severe acute respiratory syndrome coronavirus 2; Taiwan; Orthohepadnavirus; Hepadnaviridae; DNA Reverse Transcribing Viruses; viruses; Homo; Hominidae; primates; mammals; vertebrates; Chordata; animals; eukaryotes; Severe acute respiratory syndrome-related coronavirus; Betacoronavirus; Coronavirinae; Coronaviridae; Nidovirales; positive-sense ssRNA Viruses; ssRNA Viruses; RNA Viruses; APEC countries; high income countries; South East Asia; Asia; antivirals; clinical picture; chemotherapy; SARS-CoV-2; Formosa; viral infections
Full text:
Available
Collection:
Databases of international organizations
Database:
CAB Abstracts
Type of study:
Case report
Topics:
Vaccines
Language:
English
Journal:
Hepatitis Monthly
Year:
2021
Document Type:
Article
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