Kmira Zahra, Sabrine Khirallah, Monia Guermazi, Imen Akkari, Dorra Chiba, Rania Bannour, Neila Fathallah, Walid Bouteraa, Monia Zaier, Yosra Ben Youssef, Haifa Regaieg, Abderrahim Khelif
Department of Clinical Hematology, Farhat Hached University Hospital, Sousse 4000, Tunisia.
Departement of Gastrology, Farhat Hached University Hospital, Sousse 4000, Tunisia.
Vaccines (Basel). 2023 Jul 11;11(7):1228. doi: 10.3390/vaccines11071228.
An important but rare adverse effect of vaccines is their association with autoimmune events, including hepatitis and aplastic anemia (AA). In this paper, we report a case of hepatitis followed by AA that occurred after the COVID-19 vaccine was administered.
This paper focuses on a 30-year-old female who presented with acute hepatitis three weeks after receiving the second dose of the coronavirus Pfizer/BioNTech vaccine. After an extensive diagnostic evaluation was conducted that did not discover a specific cause, the Pfizer/BioNTech vaccine was suspected and the patient was treated with corticosteroids. One week after the onset of a liver disorder, the patient presented with gum bleeding and pancytopenia, and the diagnosis of AA was established via laboratory testing and bone marrow biopsy. After the diagnosis, the patient received immunosuppressive therapy using anti-lymphocyte serum (ATGAM) and CYCLOSPORINE A with progressive improvements in cytopenia. The important issue is whether AA is related to acute hepatitis or the coronavirus vaccine.
Clinicians should be aware of the risk of both the possibility of acute hepatitis, AA, or both after receiving the COVID-19 vaccination. It is very hard to distinguish the cause of AA between vaccine- and hepatitis-related AA. Predicting who develops hepatic or myelo-complications after vaccination is difficult.
疫苗的一个重要但罕见的不良反应是它们与自身免疫性事件有关，包括肝炎和再生障碍性贫血（AA）。在本文中，我们报告了一例在接种新冠疫苗后发生肝炎继而出现再生障碍性贫血的病例。
本文重点关注一名30岁女性，她在接种第二剂辉瑞/生物科技公司的新冠疫苗三周后出现急性肝炎。在进行了广泛的诊断评估但未发现具体病因后，怀疑是辉瑞/生物科技公司的疫苗所致，患者接受了皮质类固醇治疗。肝病发作一周后，患者出现牙龈出血和全血细胞减少，通过实验室检查和骨髓活检确诊为再生障碍性贫血。确诊后，患者接受了使用抗淋巴细胞血清（ATGAM）和环孢素A的免疫抑制治疗，血细胞减少症逐渐改善。重要的问题是再生障碍性贫血是否与急性肝炎或新冠疫苗有关。
临床医生应意识到接种新冠疫苗后出现急性肝炎、再生障碍性贫血或两者兼有的可能性风险。很难区分疫苗相关性再生障碍性贫血和肝炎相关性再生障碍性贫血的病因。预测接种疫苗后谁会发生肝脏或骨髓并发症很困难。
