Liver injury after SARS-CoV-2 vaccination: Features of immune-mediated hepatitis, role of corticosteroid therapy and outcome.

BACKGROUND AND AIMS: A few case reports of autoimmune hepatitis-like liver injury have been reported after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. We evaluated clinical features, treatment response and outcomes of liver injury following SARS-CoV-2 vaccination in a large case series. APPROACH AND RESULTS: We collected data from cases in 18 countries. The type of liver injury was assessed with the R-value. The study population was categorized according to features of immune-mediated hepatitis (positive autoantibodies and elevated immunoglobulin G levels) and corticosteroid therapy for the liver injury. We identified 87 patients (63%, female), median age 48 (range: 18-79) years at presentation. Liver injury was diagnosed a median 15 (range: 3-65) days after vaccination. Fifty-one cases (59%) were attributed to the Pfizer-BioNTech (BNT162b2) vaccine, 20 (23%) cases to the Oxford-AstraZeneca (ChAdOX1 nCoV-19) vaccine and 16 (18%) cases to the Moderna (mRNA-1273) vaccine. The liver injury was predominantly hepatocellular (84%) and 57% of patients showed features of immune-mediated hepatitis. Corticosteroids were given to 46 (53%) patients, more often for grade 3-4 liver injury than for grade 1-2 liver injury (88.9% vs. 43.5%, p = 0.001) and more often for patients with than without immune-mediated hepatitis (71.1% vs. 38.2%, p = 0.003). All patients showed resolution of liver injury except for one man (1.1%) who developed liver failure and underwent liver transplantation. Steroid therapy was withdrawn during the observation period in 12 (26%) patients after complete biochemical resolution. None had a relapse during follow-up. CONCLUSIONS: SARS-CoV-2 vaccination can be associated with liver injury. Corticosteroid therapy may be beneficial in those with immune-mediated features or severe hepatitis. Outcome was generally favorable, but vaccine-associated liver injury led to fulminant liver failure in one patient.

Prospective Latin American cohort evaluating outcomes of patients with COVID-19 and abnormal liver tests on admission.

INTRODUCTION & OBJECTIVES: The independent effect of liver biochemistries as a prognostic factor in patients with COVID-19 has not been completely addressed. We aimed to evaluate the prognostic value of abnormal liver tests on admission of hospitalized patients with COVID-19. MATERIALS & METHODS: We performed a prospective cohort study including 1611 hospitalized patients with confirmed SARS-CoV-2 infection from April 15, 2020 through July 31, 2020 in 38 different Hospitals from 11 Latin American countries. We registered clinical and laboratory parameters, including liver function tests, on admission and during hospitalization. All patients were followed until discharge or death. We fit multivariable logistic regression models, further post-estimation effect through margins and inverse probability weighting. RESULTS: Overall, 57.8% of the patients were male with a mean age of 52.3 years, 8.5% had chronic liver disease and 3.4% had cirrhosis. Abnormal liver tests on admission were present on 45.2% (CI 42.7-47.7) of the cohort (n = 726). Overall, 15.1% (CI 13.4-16.9) of patients died (n = 244). Patients with abnormal liver tests on admission presented higher mortality 18.7% (CI 15.9-21.7), compared to those with normal liver biochemistries 12.2% (CI 10.1-14.6); P < .0001). After excluding patients with history of chronic liver disease, abnormal liver tests on admission were independently associated with death [OR 1.5 (CI 1.1-2.0); P = 0.01], and severe COVID-19 (2.6 [2.0-3.3], P < .0001), both adjusted by age, gender, diabetes, pneumonia and body mass index >30. CONCLUSIONS: The presence of abnormal liver tests on admission is independently associated with mortality and severe COVID-19 in hospitalized patients with COVID-19 infection and may be used as surrogate marker of inflammation. CLINICALTRIALS.GOV: NCT04358380.

[Hepatic glycogenosis: a case report]. / Glucogenosis hepá tica: a propósito de un caso.

The glycogen storage diseases contain a range of diseases that are characterized by the abnormal storage or utilization of glycogen, the organs most affected being muscle and / or liver. Hepatomegaly may be a clinical sign that could guide to the diagnosis. We describe a 15-year-old patient with hepatomegaly, hypertransaminasemia and growth retardation. He was diagnosed with a glycogen storage disease by liver biopsy.

Glucogenosis hepática: a propósito de un caso / Hepatic glycogenosis: a case report

RESUMEN Las glucogenosis abarcan un rango de enfermedades que se caracterizan por el almacenamiento o utilización anormal del glucógeno, siendo los órganos más afectados el músculo y/o el hígado. La hepatomegalia puede ser un signo clínico que guie al diagnóstico. Describimos a un paciente de 15 años de edad con hepatomegalia, hipertransaminasemia y retraso del crecimiento, a quien se le diagnosticó glucogenosis por biopsia hepática.

ABSTRACT The glycogen storage diseases contain a range of diseases that are characterized by the abnormal storage or utilization of glycogen, the organs most affected being muscle and / or liver. Hepatomegaly may be a clinical sign that could guide to the diagnosis. We describe a 15-year-old patient with hepatomegaly, hypertransaminasemia and growth retardation. He was diagnosed with a glycogen storage disease by liver biopsy.

Enfermedad de Crohn: presentación de caso clínico y revisión de la literatura / CrohnÆs disease: clinical case and review of the literature

Se presenta el caso de un adolescente de sexo masculino, de 15 años de edad, con cuadro clínico de más de 2 años. El paciente presenta dolor abdominal difuso con episodios de oclusión intestinal parcial; diarrea recurrente; disminución de peso no cuantificada y periodos de alza térmica. Los análisis de laboratorio evidenciaron los siguientes resultados: PCR 92,17; albú- mina 3,2 gr/dl; anemia microcítica hipocrómica (10 gr%). En imágenes presentó: ecografía abdominal: hepatoesplenomegalia; TAC abdominal: engrosamiento de íleon distal y colon derecho con líquido libre laminar en cavidad abdominal; Radiografía de tránsito intestinal: estenosis en íleon distal. En la colonoscopía se observó: colon derecho con úlceras y áreas de mucosa infiltrada. Biopsias sugestivas de enfermedad de Crohn. Mientras que en cápsula endoscópica: ileítis ulcerativa. El paciente es dado de alta con tratamiento de prednisona y azatioprina, pero ante persistencia de episodios de oclusión intestinal se decide conducta quirúrgica. La evolución fue favorable. En el tratamiento médico posoperatorio se indicó Infliximab (Remicade). Se discuten opciones de tratamiento médico y quirúrgico...

We present a 15 year male patient with more than 2 years of clinical symptoms. Patient has abdominal pain with episodes of partial intestinal occlusion, recurrent diarrhea, weight loss and fever. Lab findings were PCR: 92, 17: albumine: 3,2 gr/dl, microcitic hipocromic anemia (10 gr%). Hepatoesplenomegaly in the Echo in TAC there was a thickness of the distal ileum and right colon with free liquid in the abdominal cavity. Intestinal transit: Stenosis of the distal ileum. In a colonoscopy: ulcers in the right colon with biopsies that suggest Crohn disease. Endoscopic capsule: ulcerative ileitis. The patient was discharged with prednisone and azatioprine but because there were new episodes of intestinal occlusion surgery was decided. The outcome was good and in the post surgery treatment Infliximab was used. We discuss medical and surgical treatment options...