Table 3.
Reported cases of liver injury following coronavirus disease 2019 vaccination
|
Ref.
|
Age/sex
|
Past history
|
Vaccine
|
Onset
|
AST/ALT (U/ L)
|
Total bilirubin (mg/ dL)
|
IgG
|
Antibody
|
Biopsy
|
Diagnose
|
Treatment
|
Outcome
|
| Bril et al[87] | 35/F | Third month postpartum | BNT162b2 | 7 d after the1st dose | 754/2001 | 4.8 | Normal | ANA: 1:1280 | Interface hepatitis, rosette formation, eosinophil infiltration | Typical for AIH | Prednisone (20 mg/d) | Improved |
| Lodato et al[88] | 43/F | Dyslipidemia | BNT162b2 | 15 d after the 1st dose | 52/51 | 17.54 | Normal | ANA: negative | Moderate portal inflammatory infiltrate with interface hepatitis, biliary injury | Compatible with AIH | Methyl-prednisolone (1 mg/kg/d) | Improved |
| Vuille-Lessard et al[89] | 76/F | Hashimoto's disease, urothelial carcinoma | mRNA-1273 | 3 d after the 1st dose | 811/579 | 3.8 | Increased | ANA: 1:1280, AMA: 1:1280 | Interface hepatitis, plasma cells infiltration, pseudorosettes | Compatible with AIH | Prednisolone (40 mg/d) + azathioprine | Improved |
| Londoño et al[90] | 41/F | Premature ovarian failure | mRNA-1273 | 7 d after the 2nd dose | 993/1312 | 2.3 | Increased | ANA: 1:80 | Interface hepatitis with a lymphoplasmacytic infiltrate | Typical for AIH | Prednisone (1 mg/kg) | Improved |
| Rocco et al[91] | 80/F | Hashimoto's disease | BNT162b2 | 7 d after the 3rd dose | 1401/1186 | 10.5 | Increased | ANA: 1:160 | Interface hepatitis with a lymphoplasmacytic infiltrate | Typical for AIH | Prednisone | Improved |
| McShane et al[92] | 71/F | Osteoarthritis | mRNA-1273 | 4 d after the 1st dose | -/1067 | 15.7 | Increased | ASMA: 1:2560 | Interface hepatitis, eosinophil infiltration | Compatible with AIH | Prednisolone (40 mg/d) | Improved |
| Clayton-Chubb et al[93] | 36/M | Hypertension | AZD1222 | 26 d after the 1st dose | 633/1774 | 9.9 | Normal | ANA: 1:160 | Interface hepatitis | Compatible with AIH | Prednisolone (60 mg/d) | Improved |
| Tan et al[94] | 56/F | None | mRNA-1273 | 35 d after the 1st dose | 1124/1701 | 5.9 | Increased | ANA: positive, ASMA: Positive | Interface hepatitis, rosette formation, eosinophil infiltration | Compatible with AIH | Budesonide | Improved |
| Ghielmetti et al[95] | 63/M | Type 2 diabetes, ischemic heart disease | mRNA-1273 | 7 d after the 1st dose | 1127/1038 | 11.9 | Increased | ANA: 1:640 | Inflammatory portal infiltrate with interface hepatitis | Typical for AIH | Prednisone (40 mg/d) | Improved |
| Zhou et al[96] | 36/F | Ulcerative colitis, primary sclerosing cholangitis | mRNA-1273 | 11 d after the 1st dose | 581/588 | 1.4 | Increased | ANA: 1:2560 | Interface hepatitis with a lymphoplasmacytic infiltrate, rosette, eosinophil | Compatible with AIH | Prednisone (50 mg/d) | Improved |
| Garrido et al[97] | 65/F | JAK2 V617F-positive polycythemia | mRNA-1273 | 14 d after the 1st dose | 1056/1092 | 1.1 | Increased | ANA: 1:100 | Interface hepatitis | Compatible with AIH | Prednisolone (60 mg/d) | Improved |
| Goulas et al[98] | 52/F | None | mRNA-1273 | 14 d after the 1st dose | 350/936 | 9.06 | Increased | ANA: 1:320, ASMA: positive | Portal, periportal inflammation, rosette formation | Typical for AIH | Prednisolone (50 mg/d) + azathioprine | Improved |
| Rela et al[99] | 38/F | Hypothyroidism | AZD1222 | 20 d after the 1st dose | 1101/1025 | 14.9 | Increased | ANA: positive | Multiacnar hepatic necrosis and periportal neocholangiolar proliferation | Compatible with AIH | Prednisolone (30 mg/d) | Improved |
| Rela et al[99] | 62/M | None | AZD1222 | 13 d after the 2nd dose | 1361/1094 | 19.2 | NA | ANA: negative | Portal neocholangiolar proliferation and mild to moderate inflammation | Compatible with AIH | Prednisolone (30 mg/d) + plasma exchange | Death |
| Palla et al[100] | 40/F | Sarcoidosis | BNT162b2 | 28 d after the 2nd dose | 4 times upper limit of normal | NA | Increased | ANA: 1:640 | Interface hepatitis with plasma cells infiltration | Compatible with AIH | Prednisolone (40 mg/d) | Improved |
| Mann et al[101] | 61/F | Irritable bowel disease, cholecystectomy | BNT162b2 | 9 d after the 2nd dose | 37/37 | 6.2 | NA | ANA: negative | Scattered inflammatory cells consisting of lymphocyte and few eosinophils | Drug induced liver injury | Conservative treatment | Improved |
| Avci et al[102] | 61/F | Hashimoto's disease, hypertension | BNT162b2 | 28 d after the 1st dose | 455/913 | 11.8 | Increased | ANA: 1:100, ASMA: 1:100 | Interface hepatitis | Compatible with AIH | Prednisolone (40 mg/d) + azathioprine | Improved |
| Torrente et al[103] | 46/F | Hypothyroidism, anemia | AZD1222 | 21 d after the 1st dose | 241/353 | Normal | Increased | ANA: 1:160 | Lymphoplasmacytic portal infiltrate | Compatible with AIH | Prednisone (30 mg/d) + azathioprine | Improved |
| Ghorbani et al[104] | 62/M | None | Corona Vac | 3 d after the 2nd dose | 722/435 | 8 | NA | ANA: negative, ASMA: negative | Interface hepatitis, infiltration of lymphocytes and eosinophils in portal tract | Compatible with AIH | Ursodeoxycholic acid | Improved |
| Kang et al[105] | 27/F | None | BNT162b2 | 7 d after the 2nd dose | 1004/1478 | 8.6 | Increased | ANA: 1:80 | Interface hepatitis with a lymphoplasmacytic infiltrate, rosette, eosinophil | Typical for AIH | Prednisolone (40 mg/d) | Improved |
| Camacho-Domínguez et al[106] | 79/M | None | AZD1222 | 15 d after the 1st dose | 2003/1994 | 11.9 | Increased | ANA: 1:80 | Interface hepatitis with a lymphocytic infiltrate, eosinophil | Compatible with AIH | Prednisone (30 mg/d) + azathioprine | Improved |
| Shahrani et al[107] | 59/F | Dyslipidemia | AZD1222 | 12 d after the 2nd dose | 962/1178 | 7.5 | Increased | NA | Lympho-plasmacellular portal infiltrate | Compatible with AIH | Prednisolone (40 mg/d) | Improved |
| Shahrani et al[107] | 63/F | Ulcerative colitis, primary sclerosing cholangitis | AZD1222 | 14 d after the 1st dose | 505/354 | 18.6 | Increased | ANA: positive | Interface hepatitis | Compatible with AIH | Prednisolone (40 mg/d) | Improved |
| Shahrani et al[107] | 72/F | None | BNT162b2 | 10 d after boostershot | 1452/2280 | 1.7 | Increased | ANA: negative, AMA: positive | Infiltration of lymphocytes and plasma cells in portal tract | Compatible with AIH | Prednisolone (40 mg/d) | Improved |
| Zin Tun et al[108] | 47/M | None | mRNA-1273 | 3 d after the 1st dose; A few days after the 2nd dose | NA/1048 | 11.3 | Increased | ANA: positive | Interface hepatitis with a lymphoplasmatic infiltrate, rosette, emperipolesis | Typical for AIH | Prednisolone (40 mg/d) | Improved |
| Suzuki et al[109] | 80/F | Gastroesophageal reflux esophagitis | BNT162b2 | 10 d after the 2nd dose | 995/974 | 3.5 | Increased | ANA: 1:40 | Lymphoplasmacytic infiltration in the portal area, interface hepatitis | Compatible with AIH | Prednisone (0.8 mg/kg/d) | Improved |
| Suzuki et al[109] | 75/F | Dyslipidemia | BNT162b2 | 4 d after the 2nd dose | 1085/820 | 17.7 | Increased | ANA: 1:80 | Lymphoplasmacytic infiltration in the portal area, interface hepatitis | Compatible with AIH | Prednisone (1.0 mg/kg/d) | Improved |
| Suzuki et al[109] | 78/F | Primary biliary cholangitis | BNT162b2 | 7 d after the 1st dose | 401/542 | 1.3 | Increased | ANA: 1:80 | Lymphoplasmacytic infiltration in the portal area, interface hepatitis | Compatible with AIH | Prednisone (0.6 mg/kg/d) | Improved |
AIH: Autoimmune hepatitis; AMA: Anti-mitochondrial antibodies; ANA: Anti-nuclear antibodies; ASMA: Anti-smooth muscle antibodies; JAK: Janus kinase; NA: Not available; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; IgG: Immunoglobulin G.