A0586 - Delayed Hepatitis Following COVID 19 mRNA Vaccine and an Accidental Booster

Mohammed Mustafa Nayeem, MD, Nida Firdous, MD, Sohaib Khan, MD
Parkview Medical Center, Pueblo, CO

Introduction: Covid 19 vaccination has become mandatory in many if not all healthcare institutions ; it is our possible gateway out of this pandemic however a small number of patients have developed unpleasant to life threatening adverse reactions.




We share with you a case of acute onset of hepatitis with symptoms lasting for 4-5 weeks following covid 19 initial vaccine and an accidental booster dose.






Case Description/Methods: 32 yr old healthy male, physician by profession, finally decided its time for Pfizer/BioNTech BNT162b2 mRNA vaccine ; 3 days later patient experienced acute onset of lethargy weakness, nausea, loss of appetite and subjective fever. These symptoms resolved within a day only to be followed by acute onset of right upper quadrant abdominal pain which progressively worsened over the next 2 weeks when patient finally got a RUQ US and LFTS.




RUQ US was positive for hepatomegaly ; LFTs reported AST 212 , ALT 446 , GGT 101 - > lfts further peaked at day 20 with ALT at 622 ,AST 232 and slowly resolved over the next week along with resolution of pain.









Patient had the booster after 2 months with negligible symptoms.




However 2 months later (4months from the initial dose) patient went into a pharmacy to obtain a Flu vaccine when he was accidentally adminsistered a dose of covid 19 BNT162b2 mRNA vaccine . Following this dose; patient had similar pattern of profound weakness, lethargy and body pains on day 2 with and similar pattern of delayed lft elevation and RUQ pain that would last over the next 4-5 weeks.




Complete hepatic workup including acute hepatitis panel, EBV, CMV, autoimmune markers ANA, anti-smooth muscle antibodies, Anti-liver/kidney microsomal antibodies, IgG were found to be negative. Patient has never had alcohol and did not take any OTC or herbal medications




It has been over a year after the last dose of the vaccine and patient has not had any symptoms thereafter.

Discussion: With 2 instances of similar pattern of symptoms and liver injury and following vaccine administration, it seems unlikely to be just a coincidence and more likely an association.




2 - 3 weeks is the optimal time at which immune system is at its peak following vaccination and also the exact time when the patients lfts peaked




. Can it be speculated that vaccine may be triggering an autoimmune response through cross reactivity leading to liver injury?




We hope to raise awareness of this potential side effects which could be benign and self resolving but cause unrelenting pain for up to 4-5 weeks following vaccination.







Disclosures:


Mohammed Mustafa Nayeem, MD, Nida Firdous, MD, Sohaib Khan, MD. A0586 - Delayed Hepatitis Following COVID 19 mRNA Vaccine and an Accidental Booster, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.