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Acute autoimmune-like hepatitis with atypical anti-mitochondrial antibody after mRNA COVID-19 vaccination: A novel clinical entity?
J Autoimmun. 2021 09; 123:102706.JA

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.

Authors+Show Affiliations

Medical Practice, Via G. Rizzi 1a, 6850, Mendrisio, Switzerland.Gastrocentroplus, Via Trevano 38, Lugano, Switzerland.King's College London Faculty of Life Sciences & Medicine, Paediatric Liver, GI and Nutrition Centre, MowatLabs, King's College Hospital, London, UK.Epatocentro Ticino, Via Soldino 5, 6900, Lugano, Switzerland.Synlab Suisse SA, Lausanne, Switzerland.King's College London Faculty of Life Sciences & Medicine, Institute of Liver Studies, MowatLabs, London, UK.Epatocentro Ticino, Via Soldino 5, 6900, Lugano, Switzerland; King's College London Faculty of Life Sciences & Medicine, Institute of Liver Studies, MowatLabs, London, UK; Faculty of Biomedical Sciences, Università Della Svizzera Italiana, 6900, Lugano, Switzerland. Electronic address: benedetta.terziroli@usi.ch.

Pub Type(s)

Case Reports
Journal Article
Review

Language

eng

PubMed ID

34293683

Citation

Ghielmetti, Michele, et al. "Acute Autoimmune-like Hepatitis With Atypical Anti-mitochondrial Antibody After mRNA COVID-19 Vaccination: a Novel Clinical Entity?" Journal of Autoimmunity, vol. 123, 2021, p. 102706.
Ghielmetti M, Schaufelberger HD, Mieli-Vergani G, et al. Acute autoimmune-like hepatitis with atypical anti-mitochondrial antibody after mRNA COVID-19 vaccination: A novel clinical entity? J Autoimmun. 2021;123:102706.
Ghielmetti, M., Schaufelberger, H. D., Mieli-Vergani, G., Cerny, A., Dayer, E., Vergani, D., & Terziroli Beretta-Piccoli, B. (2021). Acute autoimmune-like hepatitis with atypical anti-mitochondrial antibody after mRNA COVID-19 vaccination: A novel clinical entity? Journal of Autoimmunity, 123, 102706. https://doi.org/10.1016/j.jaut.2021.102706
Ghielmetti M, et al. Acute Autoimmune-like Hepatitis With Atypical Anti-mitochondrial Antibody After mRNA COVID-19 Vaccination: a Novel Clinical Entity. J Autoimmun. 2021;123:102706. PubMed PMID: 34293683.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Acute autoimmune-like hepatitis with atypical anti-mitochondrial antibody after mRNA COVID-19 vaccination: A novel clinical entity? AU - Ghielmetti,Michele, AU - Schaufelberger,Helen Dorothea, AU - Mieli-Vergani,Giorgina, AU - Cerny,Andreas, AU - Dayer,Eric, AU - Vergani,Diego, AU - Terziroli Beretta-Piccoli,Benedetta, Y1 - 2021/07/15/ PY - 2021/06/26/received PY - 2021/07/13/accepted PY - 2021/7/23/pubmed PY - 2021/8/28/medline PY - 2021/7/22/entrez KW - Atypical anti-mitochondrial antibody KW - Autoimmune-like hepatitis KW - SARS-Cov-2 KW - mRNA vaccine SP - 102706 EP - 102706 JF - Journal of autoimmunity JO - J Autoimmun VL - 123 N2 - 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. SN - 1095-9157 UR - https://www.unboundmedicine.com/medline/citation/34293683/Acute_autoimmune-like_hepatitis_with_atypical_anti-mitochondrial_antibody_after_mRNA_COVID-19_vaccination:_A_novel_clinical_entity L2 - https://linkinghub.elsevier.com/retrieve/pii/S0896-8411(21)00114-1 DB - PRIME DP - Unbound Medicine ER -