A case of acute hepatitis and morbilliform eruption after mRNA COVID-19 vaccination
Hepatology International
; 16:S307-S308, 2022.
Article
in English
| EMBASE | ID: covidwho-1995897
ABSTRACT
Objectives:
A 36-year-old Caucasian woman developed acute hepatitis and morbilliform eruption arising ten days after the first dose of the mRNA BNT162b2 SARS-CoV-2 vaccine. Materials andMethods:
The patient was asymptomatic apart from the skin rash. Liver function tests showed predmoninantly severe transaminitis (AST 523 U/L, ALT 1550 U/L, GGT 151 U/L, ALP 128 U/L, bilirubin 12 umol/L). Only the ANA 1160 was abnormal. Other serology for autoimmune and infectious diseases were negative. Multiphase computed tomography of the abdomen was unremarkable. The SARS-CoV-2 anti-spike IgG titre was 67.5 AU/mL (cut-off[15 AU/mL). The skin histology revealed spongiotic reaction pattern with focal interface lymphocytic inflammation. Multiple eosinophils and a few plasma cells were present. The epidermal lymphocytes were composed of CD2, CD3, C4, CD5, CD7 and CD8-positive T cells, with a CD4CD8 ratio of 15. A small number stained positive with TIA1, PD1 and granzyme B. CD56 staining was negative. A liver biopsy was performed after 2 days of steroids. Liver histology showed mild steatosis and mild inflammatory portal infiltrate comprising mainly of small lymphocytes that were CD3 positive with retained staining for CD7 and CD8. Lobular architecture was preserved with inconspicuous interface hepatitis or piecemeal necrosis.Results:
The patient was treated with intravenous hydrocortisone (400 mg/day) followed by prednisone (50 mg/day). There was rapid improvement in her liver function tests and cutaneous manifestations (Fig. 1).Conclusion:
mRNA COVID-19 vaccine induced hepatitis is a rare phenomenon that is steroid-responsive and has associations with cutaneous eruptions. Our patient's lack of hepatic histological abnormalties is most likely due to early immunosuppression. She had epidermal lymphocytosis with predominance of CD8-positive T cells that were not of cytotoxic phenotype and we are uncertain as to their significance. There is limited guidance on the safety of SARS-CoV-2 vaccination in those who have had developed significant hepatic and cutaenous reactions. Further work is needed.
bilirubin; CD2 antigen; CD3 antigen; CD5 antigen; CD56 antigen; CD7 antigen; CD8 antigen; endogenous compound; gamma glutamyltransferase; granzyme B; hydrocortisone; immunoglobulin G; messenger RNA; nucleolysin TIA 1 isoform p40; prednisone; tozinameran; abdomen; acute hepatitis; adult; adverse drug reaction; alanine aminotransferase blood level; aspartate aminotransferase level; autoimmune disease; case report; Caucasian; CD4 CD8 ratio; CD8+ T lymphocyte; clinical article; communicable disease; computer assisted tomography; conference abstract; coronavirus disease 2019; drug combination; drug safety; drug therapy; eosinophil; female; hepatitis; histology; histopathology; human; human cell; human tissue; hypertransaminasemia; immunoglobulin blood level; immunosuppressive treatment; inflammation; intravenous drug administration; liver biopsy; liver function test; liver histology; lymphocyte; lymphocytosis; measles like rash; necrosis; nonhuman; phenotype; plasma cell; rash; serology; Severe acute respiratory syndrome coronavirus 2; side effect; skin manifestation; spike; steatosis; vaccination
Full text:
Available
Collection:
Databases of international organizations
Database:
EMBASE
Topics:
Vaccines
Language:
English
Journal:
Hepatology International
Year:
2022
Document Type:
Article
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