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Acute autoimmune-like hepatitis with atypical anti-mitochondrial antibody after mRNA COVID-19 vaccination: A novel clinical entity?
Journal of Autoimmunity ( IF 7.9 ) Pub Date : 2021-07-15 , DOI: 10.1016/j.jaut.2021.102706
Michele Ghielmetti 1 , Helen Dorothea Schaufelberger 2 , Giorgina Mieli-Vergani 3 , Andreas Cerny 4 , Eric Dayer 5 , Diego Vergani 6 , Benedetta Terziroli Beretta-Piccoli 7
Affiliation  

Autoimmune phenomena and clinically apparent autoimmune diseases, including autoimmune hepatitis, are increasingly been reported not only after natural infection with the SARS-CoV-2 virus, but also after vaccination against it. We report the case of a 63-year old man without a history of autoimmunity or SARS-CoV-2 natural infection who experienced acute severe autoimmune-like hepatitis seven days after the first dose of the mRNA-1273 SARS-CoV-2 vaccine. Liver histology showed inflammatory portal infiltrate with interface hepatitis, lobular and centrilobular inflammation with centrilobular necrosis, in absence of fibrosis and steatosis. Serum immunoglobulin G was slightly elevated. Autoimmune liver serology showed an indirect immunofluorescence pattern on triple rodent tissue compatible with anti-mitochondrial antibody (AMA), but, unexpectedly, this pattern was not mirrored by positivity for primary biliary cholangitis (PBC)-specific molecular tests, indicating that this antibody is different from classical AMA. Anti-nuclear antibody (ANA) was also positive with a rim-like indirect immunofluorescence pattern on liver and HEp2 cell substrates, similar to PBC-specific ANA; however, anti-gp210 and a large panel of molecular-based assays for nuclear antigens were negative, suggesting a unique ANA in our patient. He carries the HLA DRB1*11:01 allele, which is protective against PBC. Response to prednisone treatment was satisfactory. The clinical significance of these novel specificities needs to be further evaluated in this emerging condition.



中文翻译:

mRNA COVID-19 疫苗接种后出现非典型抗线粒体抗体的急性自身免疫样肝炎:一种新的临床实体?

自身免疫现象和临床上明显的自身免疫性疾病,包括自身免疫性肝炎,不仅在自然感染 SARS-CoV-2 病毒后,而且在接种疫苗后也越来越多地被报道。我们报告了一名没有自身免疫病史或 SARS-CoV-2 自然感染史的 63 岁男性在首次接种 mRNA-1273 SARS-CoV-2 疫苗 7 天后出现急性重症自身免疫样肝炎的病例。肝组织学显示炎性门脉浸润伴界面性肝炎、小叶和小叶中心炎症伴小叶中心坏死,无纤维化和脂肪变性。血清免疫球蛋白G轻度升高。自身免疫性肝脏血清学显示三重啮齿动物组织的间接免疫荧光模式与抗线粒体抗体 (AMA) 相容,但出乎意料的是,这种模式并未反映在原发性胆汁性胆管炎 (PBC) 特异性分子测试的阳性结果中,表明该抗体不同于经典 AMA。抗核抗体 (ANA) 也呈阳性,在肝脏和 HEp2 细胞底物上呈环状间接免疫荧光模式,类似于 PBC 特异性 ANA;然而,抗 gp210 和大量基于分子的核抗原检测均为阴性,表明我们的患者存在独特的 ANA。他携带 HLA DRB1*11:01 等位基因,可预防 PBC。对泼尼松治疗的反应令人满意。在这种新出现的情况下,需要进一步评估这些新特异性的临床意义。表明该抗体不同于经典 AMA。抗核抗体 (ANA) 也呈阳性,在肝脏和 HEp2 细胞底物上呈环状间接免疫荧光模式,类似于 PBC 特异性 ANA;然而,抗 gp210 和大量基于分子的核抗原检测均为阴性,表明我们的患者存在独特的 ANA。他携带 HLA DRB1*11:01 等位基因,可预防 PBC。对泼尼松治疗的反应令人满意。在这种新出现的情况下,需要进一步评估这些新特异性的临床意义。表明该抗体不同于经典 AMA。抗核抗体 (ANA) 也呈阳性,在肝脏和 HEp2 细胞底物上呈环状间接免疫荧光模式,类似于 PBC 特异性 ANA;然而,抗 gp210 和大量基于分子的核抗原检测均为阴性,表明我们的患者存在独特的 ANA。他携带 HLA DRB1*11:01 等位基因,可预防 PBC。对泼尼松治疗的反应令人满意。在这种新出现的情况下,需要进一步评估这些新特异性的临床意义。抗 gp210 和大量基于分子的核抗原检测均为阴性,表明我们的患者存在独特的 ANA。他携带 HLA DRB1*11:01 等位基因,可预防 PBC。对泼尼松治疗的反应令人满意。在这种新出现的情况下,需要进一步评估这些新特异性的临床意义。抗 gp210 和大量基于分子的核抗原检测均为阴性,表明我们的患者存在独特的 ANA。他携带 HLA DRB1*11:01 等位基因,可预防 PBC。对泼尼松治疗的反应令人满意。在这种新出现的情况下,需要进一步评估这些新特异性的临床意义。

更新日期:2021-07-20
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