C0556 - Liver Histology Findings in COVID-19 Vaccine-Induced Hepatitis: A Case Series

Madeline A. Sesselmann, DO¹, David H. Kruchko, DO¹, Kaushal Majmudar, DO¹, Dean Silas, MD^2
1Advocate Lutheran General Hospital, Park Ridge, IL; ²Advocate Lutheran General Hospital, Niles, IL

Introduction: There have been reported cases of hepatitis after COVID-19 vaccination. The previously described clinical presentations and histology findings have been heterogenous, making it difficult to identify a definitive pattern of liver injury. We present a series of three patients with elevated liver enzymes after Pfizer COVID-19 vaccination who underwent liver biopsy.

Case Description/Methods: Patient 1, a 32-year-old male in good health, presented with elevated liver enzymes on routine outpatient labs. He was asymptomatic and physical exam was unremarkable. He had received his second dose of the COVID vaccine 27 days prior. Serologic liver workup and biopsy findings can be found in Table 1. He was treated with ursodiol 500 mg twice daily, with significant improvement in liver enzymes after 30 days.

Patient 2, a 56-year-old male with history of diabetes presented with nausea, pruritis and painless jaundice. Jaundice and diffuse excoriations were seen on exam. Liver enzymes were elevated and serologic liver workup and biopsy findings can be found in Table 1. His third COVID-19 vaccination was 5 days prior to presentation. The patient was treated with IV steroids for 5 days, with short term improvement in liver enzymes.

Patient 3, an 85-year-old male with history of dyslipidemia and NSTEMI presented with dark urine and poor oral intake. Scleral icterus was noted on physical exam. Liver enzymes were elevated, and serologic liver workup and biopsy findings can be found in Table 1. He received his third COVID-19 vaccine 4 days prior. He was treated with prednisone taper with complete resolution of liver enzymes after 3 months.

Discussion: This case series suggests a possible correlation between Pfizer COVID-19 vaccination and hepatitis as demonstrated by liver biopsy findings. All three patients had no prior history of underlying liver disease, alcohol use or identifiable risk factors. Patient presentation was variable in terms of clinical symptoms, serologic workup and even histology findings. The common thread was elevated immunoglobulins suggesting an immune component without findings of autoimmune hepatitis. This is consistent with a previously published case series of COVID-19 vaccine-induced hepatitis. We share our findings to add to the collective repository of COVID-19 vaccine-induced hepatitis to add to existing literature and with the hope of increasing awareness.



Disclosures:


Madeline A. Sesselmann, DO¹, David H. Kruchko, DO¹, Kaushal Majmudar, DO¹, Dean Silas, MD². C0556 - Liver Histology Findings in COVID-19 Vaccine-Induced Hepatitis: A Case Series, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.