Medicina del Aparato Digestivo, Hospital Universitario 12 de Octubre, España.
Anatomía Patológica, Hospital Universitario 12 de Octubre.
Rev Esp Enferm Dig. 2022 Sep;114(9):567-568. doi: 10.17235/reed.2022.8820/2022.
SARS-CoV2 infection and vaccination against this virus have been related to the development of autoimmune diseases. We report a case of autoimmune hepatitis (AIH) after SARS-COV2 vaccine. Male, 76 years old, with a history of hepatic cirrhosis secondary to primary biliary cholangitis (PBC), compensated, treated with ursodeoxycholic acid and obeticholic acid. The patient received the third dose of the SARS-CoV2 vaccine (BioNTech/Pfizer) in December 2021. In subsequent analytical control, the patient presented altered liver test, with elevation of ALT and AST. Ultrasound was performed, without alterations, and viral causes were ruled out. IgG elevation and positive antinuclear antibodies were observed. A liver biopsy was performed, with findings of intense interface and lobular hepatitis and areas of centrilobular necrosis. The inflammation was predominantly lymphoplasmacytic. The patient was diagnosed with AIH and initiated therapy with steroids and azathioprine, currently with an adequate response. AIH is an immune-mediated disease of uncertain etiology. Cases of AIH with SARS-CoV2 vaccination as a possible trigger have recently been published, with characteristics similar to ours. Some of them had a history of autoimmune pathology, such as this case (PBC). Therefore, it is suggested that vaccination can induce the development of autoimmune pathology in patients at risk. Our reported case reinforces the hypothesis of an association between AIH and the SARS-CoV2 vaccine.
SARS-CoV2 感染和针对该病毒的疫苗接种与自身免疫性疾病的发展有关。我们报告了一例 SARS-COV2 疫苗接种后发生的自身免疫性肝炎 (AIH)。男性，76 岁，患有原发性胆汁性胆管炎 (PBC) 继发的肝硬化，代偿良好，接受熊去氧胆酸和奥贝胆酸治疗。该患者于 2021 年 12 月接种了第三剂 SARS-CoV2 疫苗 (BioNTech/Pfizer)。在随后的分析性控制中，患者出现了肝功能检查异常，ALT 和 AST 升高。进行了超声检查，未发现异常，并排除了病毒原因。观察到 IgG 升高和抗核抗体阳性。进行了肝活检，结果显示强烈的界面和小叶性肝炎以及中央静脉坏死区域。炎症主要为淋巴浆细胞性。患者被诊断为 AIH，并开始接受类固醇和硫唑嘌呤治疗，目前反应良好。AIH 是一种病因不明的免疫介导性疾病。最近有几例 AIH 与 SARS-CoV2 疫苗接种作为可能的诱因有关，其特征与我们的病例相似。其中一些患者有自身免疫性疾病病史，如本例 (PBC)。因此，建议疫苗接种可能会在有风险的患者中诱发自身免疫性疾病的发展。我们报告的病例进一步支持了 AIH 与 SARS-CoV2 疫苗之间存在关联的假设。
