Several
vaccines have been developed for
coronavirus disease 2019 (COVID-19) and are used worldwide. Here we report a case of severe acute
hepatitis induced by
COVID-19 vaccination. A 54-year-old woman received two doses of the Pfizer-BioNTech
COVID-19 mRNA vaccine and an additional dose of the Moderna
COVID-19 mRNA vaccine. Seven days after the third dose, she noticed
fatigue, appetite loss and dark urine. Laboratory tests were consistent with severe liver injury and
jaundice. Anti-smooth muscle antibody and
HLA-DR4 were positive; thus, we suspected that she had
autoimmune hepatitis (AIH). Intravenous
methylprednisolone followed by oral
prednisolone were administered. Because remission was not achieved, we performed percutaneous liver biopsy. Histologically, pan-lobular
inflammation with moderate infiltration of lymphocytes and macrophages, interface
hepatitis, and rosette formation were present. We regarded these findings as confirmation of the diagnosis of AIH. As she had not responded to
corticosteroids, we added
azathioprine. Liver biochemistry tests gradually improved, and
prednisolone could be tapered without relapse of AIH. Dozens of cases of AIH after
COVID-19 vaccination have been reported.
Corticosteroids were effective in most cases, but some patients have died from
liver failure after vaccination. This case illustrates the efficacy of
azathioprine for
steroid-refractory AIH induced by
COVID-19 vaccination.