Peculiarity of autoimmune hepatitis triggered by SARS-CoV-2 infection
  • Antonella Gallo
    Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
  • Francesca Ibba
    Università Cattolica del Sacro Cuore, Rome, Italy
  • Maria Grazia Massaro
    Università Cattolica del Sacro Cuore, Rome, Italy
  • Fiammetta Rognoni
    Università Cattolica del Sacro Cuore, Rome, Italy
  • Maria Cristina Giustiniani
    Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
  • Francesca Romana Ponziani
    Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
  • Massimo Montalto
    Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy

Keywords

Acute hepatitis, COVID-19, autoimmunity

Abstract

Introduction: Recently, medical interest has been growing in SARS-CoV-2 infection and its multiorgan involvement, including the liver. Up until now, a few reports have described autoimmune hepatitis (AIH) triggered by SARS-CoV-2 infection, but no data are available about the specific liver inflammatory infiltrate and cluster of differentiation. We report a case of AIH triggered by SARS-CoV-2 infection, with a particular focus on its histological and mainly immunohistochemical features.
Case description: A 60-year-old man, with a history of paucisymptomatic SARS-CoV-2 infection that occurred one month earlier, was admitted for alterations of hepatocellular necrosis and cholestasis indexes. He completed vaccination for SARS-CoV-2 a year earlier. The serologies for hepatotropic viruses were negative. The anti- smooth muscle antibodies (ASMA) and antinuclear antibodies (ANA) results were positive. Anti-liver kidney microsome (anti-LKM) antibodies and antimitochondrial (AMA) were negative. By liver biopsy, haematoxylin-eosin staining highlighted severe portal inflammation with a rich CD38+ plasma cell component, while immunohistochemical staining showed low cell CD4+ count and prevalence of CD8+ and CD3+. After biopsy, the patient started an immunosuppressant regimen, with benefit.
Discussion: We can conclude that the patient developed a type 1 AIH triggered by SARS-CoV-2 infection. The presence of CD8 T-cells at immunohistochemical examination suggests different mechanisms from classic AIH. Similar cases are described after AIH triggered by SARS-CoV-2 vaccination.
Conclusion: The AIH after SARS-CoV-2 infection developed by the patient showed a histological picture similar to a classic AIH for the abundant presence of plasma cells, and immunohistochemical features similar to those described after SARS-CoV-2-vaccination.

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    Published: 2023-11-29
    Issue: 2024: Vol 11 No 1 (view)

    How to cite:
    1.
    Gallo A, Ibba F, Massaro MG, Rognoni F, Giustiniani MC, Ponziani FR, Montalto M. Peculiarity of autoimmune hepatitis triggered by SARS-CoV-2 infection. EJCRIM 2023;11 doi:10.12890/2023_004195.

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