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Recovery from post-COVID-19 vaccination biliary ductopenia and multiorgan inflammation: A case with insight from angiotensin II type 1 receptor antibody- mediated injury (preprint)
researchsquare; 2023.
Preprint
in English
| PREPRINT-RESEARCHSQUARE | ID: ppzbmed-10.21203.rs.3.rs-2917943.v1
ABSTRACT
Background The coronavirus disease 2019 (COVID-19) pandemic has caused significant morbidity and mortality. Spike messenger RNA (mRNA)–based vaccines against severe acute respiratory syndrome coronavirus 2 may contribute to immune-mediated injuries. Here we present a case of marked cholangiopathy with multiorgan injury and investigate the potential mechanisms associated with mRNA-based vaccines. Case summary and investigation A previously healthy 47-year-old man developed progressive jaundice 2 weeks after receiving his 3rd COVID-19 vaccination (1st mRNA-based vaccine). Apart from elevated serum total bilirubin levels (peaked at >70 mg/dL), deteriorating renal (blood urea nitrogen peak, 108.5 mg/dL; creatinine peak, 6 mg/dL) and exocrine pancreas (amylase peak, 1717 U/L; lipase peak, 5784 U/L) profiles were also seen. Vanishing bile duct syndrome characterized by ductopenia and cholangiocyte vacuolation, positive C4d deposition, and high titer of anti-angiotensin II type 1 receptor antibody consistently explain the overall antibody-mediated pathogenesis resembling antibody-mediated “rejection” in the solid organ transplant setting. Corticosteroids and plasmapheresis were administered, leading to gradual resolution of the symptoms, and the jaundice completely resolved 2 months later. Conclusion Here we reported a case of antibody-mediated multiorgan injury after an mRNA COVID-19 vaccine characterized by severe cholangiopathy. The patient recovered with corticosteroids and plasmapheresis, and long-term follow-up is needed.
Full text:
Available
Collection:
Preprints
Database:
PREPRINT-RESEARCHSQUARE
Main subject:
Bile Duct Diseases
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Biliary Tract Neoplasms
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Coronavirus Infections
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Chemical and Drug Induced Liver Injury
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COVID-19
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Inflammation
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Jaundice
Language:
English
Year:
2023
Document Type:
Preprint
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