Acute autoimmune-like hepatitis with atypical anti-mitochondrial antibody after mRNA COVID-19 vaccination: A novel clinical entity?. Issue 123 (September 2021)

• Record Type: Journal Article
• Authors: Ghielmetti, Michele; Schaufelberger, Helen Dorothea; Mieli-Vergani, Giorgina; Cerny, Andreas; Dayer, Eric; Vergani, Diego; Terziroli Beretta-Piccoli, Benedetta
• Is Part Of: Journal of autoimmunity. Issue 123(2021)
• Publication Date: 2021-09
• Subjects: SARS-Cov-2 -- mRNA vaccine -- Autoimmune-like hepatitis -- Atypical anti-mitochondrial antibody; Autoimmunity -- Periodicals; Autoimmune diseases -- Periodicals; Autoantibodies -- Periodicals; Autoimmune Diseases -- Periodicals; Auto-immunité -- Périodiques; Maladies auto-immunes -- Périodiques; Electronic journals; 616.978005
• DOI: 10.1016/j.jaut.2021.102706
• Languages: English
• ISSNs: 0896-8411

Abstract

Abstract: Autoimmune phenomena and clinically apparent autoimmune diseases, including autoimmune hepatitis, are increasingly been reported not only after natural infection with the SARS-CoV-2 virus, but also after vaccination against it. We report the case of a 63-year old man without a history of autoimmunity or SARS-CoV-2 natural infection who experienced acute severe autoimmune-like hepatitis seven days after the first dose of the mRNA-1273 SARS-CoV-2 vaccine. Liver histology showed inflammatory portal infiltrate with interface hepatitis, lobular and centrilobular inflammation with centrilobular necrosis, in absence of fibrosis and steatosis. Serum immunoglobulin G was slightly elevated. Autoimmune liver serology showed an indirect immunofluorescence pattern on triple rodent tissue compatible with anti-mitochondrial antibody (AMA), but, unexpectedly, this pattern was not mirrored by positivity for primary biliary cholangitis (PBC)-specific molecular tests, indicating that this antibody is different from classical AMA. Anti-nuclear antibody (ANA) was also positive with a rim-like indirect immunofluorescence pattern on liver and HEp2 cell substrates, similar to PBC-specific ANA; however, anti-gp210 and a large panel of molecular-based assays for nuclear antigens were negative, suggesting a unique ANA in our patient. He carries the HLA DRB1*11:01 allele, which is protective against PBC. Response to prednisone treatment was satisfactory. The clinical significance of these novel specificities needs to be further evaluated in this emerging condition. Highlights: A case of acute severe autoimmune-like hepatitis after mRNA-1273 SARS-CoV-2 vaccine. Indirect immunofluorescence compatible with anti-mitochondrial antibody. Negative primary biliary cholangitis-specific molecular tests. Positive anti-nuclear antibody with a rim-like and speckled patterns on HEp2 cells. Negative anti-gp210 and multiple molecular-based assays for nuclear antigens.