AUTOIMMUNE HEPATITIS FOLLOWING COVID-19 VACCINATION: A SYSTEMATIC REVIEW OF THE LITERATURE

ABSTRACT

Introduction COVID-19 vaccines have been shown to be effective in preventing hospitalization due to COVID-19 infection. However, safety remains a concern. Some studies have linked the vaccine to the development of autoimmune diseases such as myocarditis and immune thrombocytopenic purpura. During the summer of 2021, an increasing number of case reports began to emerge documenting a small number of individuals who developed autoimmune hepatitis (AIH) following COVID-19 vaccination. These cases are rare, novel, and very little is known. In our systematic review, we analyzed every published case of AIH and reviewed their characteristic findings, treatment, and outcomes. Methods We searched PubMed, Embase, and Web of Science from 1 December 2019 to 1 November 2021. Keywords included but were not limited to “COVID-19,” “vaccine,” and “autoimmune hepatitis.” Two researchers independently extracted information from the articles about vaccine type, patient history, characteristics, laboratory values, histology results, treatment regimens, and disease course. Results Thirty-two patients developed AIH after receiving a COVID-19 vaccine (16 Pfizer-BioNTech, 13 Moderna, 3 Oxford-AstraZeneca), of whom 17 were from the United States, 11 were from Europe, 3 were from Asia, and 1 was from Australia. Sixty-nine percent of patients were women and 58% had no history of liver or autoimmune disease. Jaundice was the most common symptom (81%). Nineteen percent of patients were initially asymptomatic and presented with abnormal liver enzymes found during routine bloodwork. (Table 1) Mean ALT, AST, and bilirubin were 1231 U/L, 921 U/L, and 14 mg/dL. Anti-nuclear antibody and anti-smooth muscle antibody were positive in 56% and 28% of patients. Liver biopsy was performed in 81% of patients with findings strongly suggestive of AIH. Corticosteroids were used in 74% of patients with a mean time to disease resolution of 28 days. Improvement or complete resolution was seen in 97% of patients. (Table 2) One patient died despite aggressive steroid treatment. Discussion COVID- 19 vaccine-induced AIH is extremely rare with just 32 documented cases in the literature. Although causality cannot be proved, this phenomenon should not be treated as coincidence. Clinicians should be aware of this rare but real complication and suspect vaccine-induced AIH in patients who present with jaundice and abnormal liver enzymes following COVID- 19 vaccination. Treatment with corticosteroids appears to be highly effective, with improvement or resolution in 97% of patients. Our findings highlight the rarity of COVID-19 vaccine-induced AIH and should under no circumstances deter individuals from getting vaccinated as the benefits of vaccination far outweigh the risks. (Table Presented)