Acute liver injury and IgG4-related autoimmune pancreatitis following mRNA-based COVID-19 vaccination

Abstract

IgG4-related disease (IgG4-RD) is a fibro-inflammatory disease that can affect multiple organs. Autoimmune pancreatitis type 1 is a manifestation of IgG4-RD and can often mimic tumor-like masses. Autoimmune phenomena following COVID-19 mRNA vaccination are being increasingly reported. Currently, there are no cases in which IgG4-RD involving the hepatobiliary system has been reported following the COVID-19 vaccination. We present the first case of IgG4-RD and AIP type 1 to be associated with the mRNA-based COVID-19 vaccination.

Keywords: Autoimmune pancreatitis; COVID-19; IgG4; mRNA vaccine.

Figure 1

(a) CT abdomen/pelvis with IV/PO contrast showing increased fullness to the pancreatic head with a hypo-enhancing mass-like lesion measuring up to 3 cm. (b, c) CT triple phase liver showing hypervascular arterial enhancing pancreatic head mass measuring up to 3.6 X 2.6 X 5.5 cm in the largest dimensions. (d) Compared with prior studies (previous images), the pancreas is no longer swollen and edematous, but appears somewhat atrophic. No definite enhancing masses are seen in the head of the pancreas.