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.
Approach& 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 Steroid therapy was withdrawn during the observation period in 12 (26%) patients after complete biochemical resolution.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.
https://aasldpubs.onlinelibrary.wiley.com/doi/10.1002/hep.32572
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450 cases of pediatric hepititis have been reported, most in previously healthy kids under age 5
The growing constellation of cases has spurred an international hunt to identify the culprit, with disease detectives and researchers from global health agencies, the United States, the U.K., Israel, Italy and Japan weighing in to share data and hypotheses. Hepatitis, which is an inflammation of the liver, is typically caused by one of several known viruses — hepatitis A, B, C, D or E. But those have all been ruled out in these cases, which are also unusually severe.
https://www.washingtonpost.com/health/2022/05/17/hepatitis-children-investigation-cause/?tid=pm_pop