Biomedicines (Oct 2023)

Investigating Acute Hepatitis after SARS-CoV-2 Vaccination or Infection: A Genetic Case Series

  • Elisa Bernasconi,
  • Matteo Biagi,
  • Stefania Di Agostino,
  • Carmela Cursaro,
  • Cristina Felicani,
  • Enrico Ronconi,
  • Elena Franchi,
  • Arianna Carmen Costanzo,
  • Filippo Gabrielli,
  • Alessia Cavicchioli,
  • Giuseppe Ienopoli,
  • Paolo Marenghi,
  • Alessandra Bartoli,
  • Beatrice Serra,
  • Davide Scalabrini,
  • Pamela Sighinolfi,
  • Pietro Andreone

DOI
https://doi.org/10.3390/biomedicines11102848
Journal volume & issue
Vol. 11, no. 10
p. 2848

Abstract

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(1) Background: Despite the advantages of COVID-19 vaccination, rare cases of acute hepatitis developing after the administration of the COVID-19 vaccine or the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been reported. The aim of the study is to describe a case series of patients who experienced the onset of acute hepatitis, with or without autoimmune features, following SARS-CoV-2 vaccination or infection and to hypothesize a genetic susceptibility in the pathogenesis. (2) Methods: A group of patients with acute onset hepatitis following SARS-CoV-2 vaccination or infection were evaluated in our hepatology outpatient clinic, where they underwent biochemical and autoimmune tests. Hepatitis A (HAV), B (HBV), and C virus (HCV), cytomegalovirus (CMV), Epstein–Barr virus (EBV), and human immunodeficiency virus (HIV) infections were excluded. Patients with a diagnosis of autoimmune hepatitis (AIH) or drug-induced liver injury (DILI) underwent HLA typing and histological testing. (3) Results: Five patients experienced new-onset AIH after COVID-19 vaccination, one of which developed mild symptoms after vaccination that strongly worsened during subsequent SARS-CoV-2 infection. One patient had AIH relapse after COVID-19 vaccination while on maintenance immunosuppressive treatment. All of them had HLA DRB1 alleles known to confer susceptibility to AIH (HLA DRB1*03,*07,*13,*14), and in three of them, HLA DRB1*11 was also detected. Two patients developed acute hepatitis without autoimmune hallmarks which resolved spontaneously, both positive for HLA DRB1*11. (4) Conclusions: An association between AIH and COVID-19 vaccine or infection can be hypothesized in individuals with a genetic predisposition. In patients without autoimmune features and spontaneous improvement of hypertransaminasemia, the diagnosis of drug-induced liver injury (DILI) is probable. Further studies are needed to determine the presence of an actual association and identify a possible role of HLA DRB1*11 in the pathogenesis of acute liver injury after SARS-CoV2 vaccination or infection.

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