Clinicopathological Characteristics of Autoimmune-Like Hepatitis Induced by COVID-19 mRNA Vaccine (Pfizer-BioNTech, BNT162b2): A Case Report and Literature Review

Abstract

Widespread use of vaccinations worldwide in the coronavirus disease (COVID-19) pandemic has resulted in various side effects. Here, we presented a 27-year-old man with autoimmune-like hepatitis after the first dose of the BNT162b2 (mRNA) COVID-19 vaccine and reviewed previous reports. He presented with sweating, febrile sensations, and general weakness. He did not have any medical histories. Although he was treated with biphenyl dimethyl dicarboxylate and ursodeoxycholic acid, the elevated liver enzyme levels persisted for 2 months. Liver biopsy demonstrated portal inflammation with rosette formation, interface hepatitis, and infiltration of lymphocytes, histiocytes, plasma cells, and eosinophils. Especially, centrilobular edema and necrosis were found. The symptoms and liver enzymes improved with prednisolone treatment. If persistently elevated liver enzymes are found after COVID-19 mRNA vaccination, the possibility of autoimmune-like hepatitis induced by the vaccine should be considered and a careful pathologic evaluation is required.

Keywords: autoimmune hepatitis; coronavirus; drug-induced liver injury; mRNA vaccine; vaccination.

Figure 1.

Trends of liver function test. AST, aspartate transaminase; ALT, alanine transaminase.

Figure 2.

Microscopy shows portal inflammation with interface hepatitis (A, ×100). The infiltrated cells are mostly CD8 T lymphocytes (A, inset, CD8). Prominent plasma cells with some eosinophils were infiltrated in portal area (B, ×400). The centrilobular lesion shows mild edema, necrosis, and infiltrates of lymphocytes and histiocytes (C, ×400).