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Case Reports
. 2022 Oct 14;14(10):e30304.
doi: 10.7759/cureus.30304. eCollection 2022 Oct.

COVID-19 Vaccination-Induced Cholangiopathy and Autoimmune Hepatitis: A Series of Two Cases

Mansoor Zafar  1 , Katherine Gordon  2 , Lucia Macken  2 , Joe Parvin  1 , Simon Heath  3 , Max Whibley  3 , Jeremy Tibble  4
Affiliations
Case Reports

COVID-19 Vaccination-Induced Cholangiopathy and Autoimmune Hepatitis: A Series of Two Cases

Mansoor Zafar et al. Cureus. .

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has been associated with significant morbidity and mortality. Following the introduction of vaccines, various side effects have been reported. Whilst those reported may be attributed to the vaccine itself, at times, it may simply incite an immunological phenomenon. We present a case series of two patients who presented with symptoms of yellowing of the eyes and the skin along with fatigue, and tiredness, following vaccination for COVID-19. The diagnosis of post COVID-19-vaccination related hepatitis is one of the fewer, less understood, yet reported side effects associated with significant morbidity. The diagnosis of COVID-19 vaccination-related cholangitis is an outcome reported here for the first time to the best of our knowledge. It was alarming that both patients did not have any significant past history of medical ailments. A prompt assessment followed by investigations including liver biopsy assisted in a timely understanding of the phenomenon with complete resolution of the symptoms.

Keywords: alt (alanine aminotransferase); c –reactive protein (crp); emergency medical service; hematoxylin & eosin; liver function tests (lfts); magnetic resonance cholangiopancreatography (mrcp); mrna.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Magnetic resonance cholangiography (MRCP) diffusion-weighted image
Bile duct stricturing (yellow arrows). Dilated proximal pancreatic duct (blue arrow) with prominent common bile duct (red arrow).
Figure 2
Figure 2. Liver tissue biopsy with H&E stain
H&E: Haematoxylin & Eosin stain, Magnification: (A) x 100um, and (B) x 200um. Images show mild chronic portal inflammation (yellow arrows) with evidence of ductitis (blue bold arrow).
Figure 3
Figure 3. Liver tissue biopsy with CK7 stain
CK7: Cytokeratin 7 stain with magnification x 300um. The image highlights a ductular proliferation at the interface (red arrows).
Figure 4
Figure 4. Ultrasound images
A and B: ultrasound liver demonstrates mild irregular margin with coarse texture (yellow arrows) and markedly thickened gallbladder wall (red arrows), with mild to moderate ascites (blue arrows).
Figure 5
Figure 5. Liver tissue biopsy with H&E stain
H&E: Haematoxylin & Eosin, Magnification x 200um The image shows mild chronic portal inflammation with scattered eosinophils (red bold arrows), Zone 1 with hepatocyte ballooning (yellow arrows), and lytic foci (blue arrows).
See this image and copyright information in PMC

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