Reveals clues to liver dysfunction after corona vaccination

[이데일리 이순용 기자] T-cells causing autoimmune liver disease as a result of a liver biopsy of a patient vaccinated against the corona virus by a team led by Professor Seong Pil-su (corresponding author), Gastroenterology Department, Incheon St. Mary’s Hospital, Gastroenterology Department, Catholic University of Korea, Seoul St. Mary’s Hospital was developed, and a case was reported in the ‘Journal of Hepatology’, the most prestigious international academic journal in the field of hepatology.

In April this year, a research team from the University of Freiburg, Germany, published in the same academic journal, “After the corona vaccine, specific CD8+ T cells for this cause liver damage, which can cause autoimmune liver disease.” is a case In particular, hepatic overlap syndrome, in which autoimmune hepatitis and primary biliary cholangitis co-occur after corona vaccination, is the world’s first report.

The patient was a 57-year-old woman with no history of taking drugs for underlying diseases, alcohol, or liver disease, and was referred to Seoul St. Mary’s Hospital after feeling weak. Two weeks after the first dose of corona vaccine, she felt tired and weak in general, so she went to the hospital, and the results of the physical examination were normal. The liver function level was normal at regular health checkups, but the blood test performed during this visit confirmed that the liver level, which is used to diagnose liver disease, increased.

In the tests performed to determine the cause, hepatitis A, B, C, and E, and viral hepatitis test results such as cytomegalovirus and herpes simplex virus type 1 and 2 were negative, and liver ultrasound was also performed. There were no special findings. On the other hand, the autoantibody test showed positive antinuclear antibody and anti-mitochondrial antibody, confirming the high possibility of autoimmune liver disease including hepatic duplication syndrome.

As a result of the liver tissue biopsy performed for diagnosis, it was confirmed that immune cells, T cells, were concentrated in the portal vein, infiltrated, and necrosis of the liver tissue. In addition, interfacial hepatitis and non-purulent cholangitis, in which plasma cell infiltration, fragment necrosis, and inflammation and necrosis of the portal vein are extended to the periphery of the portal vein, were also observed. It was confirmed that it was progressive hepatic duplication syndrome.

[환자의 간 조직병리학적 소견] Confirmation of hepatic portal vein severity inflammation and fragment necrosis and interfacial hepatitis during H&E staining (left) / Confirmation of rosette formation that looks like rosettes due to attachment of other cells around liver cells (right)

Combining these findings, the patient met the diagnostic criteria for hepatic duplication syndrome and recovered to normal liver values ​​within 2 weeks after appropriate treatment including high-dose ursodeoxycholic acid (UDCA).

Professor Lee Soon-gyu, Department of Gastroenterology, Incheon St. Mary’s Hospital said, “This study is very meaningful in providing a clue to the mechanism that liver damage and liver function abnormalities can occur due to immune response after vaccination. Therefore, it is important to identify and treat them through detailed questionnaires and examinations when treating patients.”

Professor Seong Pil-su, Department of Gastroenterology, Seoul St. Mary’s Hospital said, “This paper is the first report on hepatic duplication syndrome after vaccine, and careful observation and confirmation of immune response and immune liver disease is required. We will do our best to help patients.”

Autoimmune liver disease is a disease in which the immune system determines that one’s own liver cells are also harmful and causes inflammation on their own. In the early stages of the onset, fatigue, nausea, vomiting, and loss of appetite appear. Although jaundice may occur, some patients do not have any symptoms at all, so some patients do not find it at an early stage and seek hospitalization only after complications such as edema, blood clotting disorder, and varicose bleeding progress.

Diagnosis is often difficult because it cannot be diagnosed with a single test. Diagnosis is made by synthesizing and scoring various tests such as blood tests and liver biopsies. Depending on the lesion site, there are autoimmune infection in which hepatocytes are damaged, primary biliary cholangitis in which the biliary tract and biliary duct cells are damaged, and primary sclerosing cholangitis. Duplicate syndrome in which two or more diseases develop may occur.

Of these, if autoimmune hepatitis is not treated in time, about half of the patients will develop cirrhosis within 15 years. However, early diagnosis and treatment results in good results, and treatment methods are different for each disease. Therefore, early diagnosis and appropriate treatment are important.

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