Bernasconi Elisa, Biagi Matteo, Di Agostino Stefania, Cursaro Carmela, Felicani Cristina, Ronconi Enrico, Franchi Elena, Costanzo Arianna Carmen, Gabrielli Filippo, Cavicchioli Alessia, Ienopoli Giuseppe, Marenghi Paolo, Bartoli Alessandra, Serra Beatrice, Scalabrini Davide, Sighinolfi Pamela, Andreone Pietro
Department of Internal Medicine, Civil Hospital of Baggiovara, University of Modena and Reggio Emilia, Baggiovara, 41126 Modena, Italy.
Department of Internal Medicine, General, Emergency and Post-Acute, Division of Metabolic Internal Medicine, Civil Hospital of Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Baggiovara, 41126 Modena, Italy.
Biomedicines. 2023 Oct 20;11(10):2848. doi: 10.3390/biomedicines11102848.
(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 DRB111 was also detected. Two patients developed acute hepatitis without autoimmune hallmarks which resolved spontaneously, both positive for HLA DRB111. (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 DRB111 in the pathogenesis of acute liver injury after SARS-CoV2 vaccination or infection.
(1) 背景：尽管新冠病毒疫苗接种有诸多益处，但仍有报告称在接种新冠病毒疫苗或感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）后出现了罕见的急性肝炎病例。本研究的目的是描述一组在接种SARS-CoV-2疫苗或感染后出现急性肝炎（有或无自身免疫特征）的病例系列，并推测发病机制中的遗传易感性。(2) 方法：在我们的肝病门诊对一组在接种SARS-CoV-2疫苗或感染后急性起病的肝炎患者进行了评估，他们在那里接受了生化和自身免疫检测。排除了甲型肝炎病毒（HAV）、乙型肝炎病毒（HBV）、丙型肝炎病毒（HCV）、巨细胞病毒（CMV）、EB病毒（EBV）和人类免疫缺陷病毒（HIV）感染。诊断为自身免疫性肝炎（AIH）或药物性肝损伤（DILI）的患者接受了HLA分型和组织学检测。(3) 结果：5名患者在接种新冠病毒疫苗后出现新发AIH，其中1例在接种疫苗后出现轻微症状，在随后的SARS-CoV-2感染期间症状严重恶化。1例患者在接种新冠病毒疫苗且正在接受维持性免疫抑制治疗时出现AIH复发。他们所有人都具有已知易患AIH的HLA DRB1等位基因（HLA DRB1*03、07、13、14），其中3人还检测到HLA DRB111。2例患者出现无自身免疫特征的急性肝炎，且均自行缓解，两人的HLA DRB111均呈阳性。(4) 结论：对于有遗传易感性的个体，可以推测AIH与新冠病毒疫苗或感染之间存在关联。在无自身免疫特征且高转氨酶血症自行改善的患者中，药物性肝损伤（DILI）的诊断可能性较大。需要进一步研究以确定是否存在实际关联，并确定HLA DRB111在SARS-CoV2疫苗接种或感染后急性肝损伤发病机制中的可能作用。
