P3016 - An Unexpected Cause of Liver Injury

Nada Saleh, MD, Sultan Ahmed, DO, Luqman Baloch, MD, Christine Junia, MD, Thayer Hamoudah, MD
Mercy Health, Rockford, IL

Introduction: Vaccination against COVID-19 continues to be a recommended practice with documented mortality benefits during the pandemic. With an understanding of the vaccine effects still evolving, we present a case of a patient who presented with fatigue and abnormal liver function tests after COVID-19 mRNA-1273 vaccination.

Case Description/Methods: A 69-year-old female with a past medical history of cholecystectomy and colonic polyps presented to her primary care office with fatigue, myalgia, and anorexia one week after getting her fourth COVID-19 vaccination. Labs showed AST/ALT at 121/103 U/Land ALP at 136 U/L. Repeat labs after one week showed an upward trend with AST/ALT of 341/448 U/L and ALP of 382 U/L – prompting her to be sent to the ED. No sign of acute liver failure was noted. She denied alcohol use, IV drug use, tattoos, herbal supplements, or new medications. Ultrasound of the abdomen was negative for any significant findings. Liver Doppler revealed patent hepatic and portal veins. Labs noted a mildly positive but insignificant EBV PCR at 147 IU/mL . All other labs were negative including hepatitis A/B/C serologies, anti-smooth muscle antibody, anti-mitochondrial antibody, alpha-1 anti-trypsin levels, celiac serology, ceruloplasmin, iron studies, HSV, CMV, & VZV. The patient was noted to have a low positive ANA titer 1:80. Repeat labs during admission showed improvement of liver enzymes. Patient was discharged with outpatient follow up, and liver biopsy was offered however declined. Repeat blood work a month after showed near normalization of her ALT, AST, & ALP.

Discussion: A study conducted by Efe et al showed that, due to activation of the interferon pathway, immune-mediated hepatocellular injury was seen with mRNA COVID-19 vaccination. Auto-immune workup was positive with elevated IgG levels noted to be statistically significant. According to NIH’s Liver-Tox mRNA vaccines are considered Class C drugs, but autoimmune activation and portal vein thrombosis have been reported in rare cases. In this case, lab workup was insignificant other than ANA titers being mildly positive. Given the timeline it's likely her symptoms were secondary to the vaccine. Although any patient that presents with similar findings should undergo complete work up, it is beneficial for practitioners to recognize that elevated transaminases can be an adverse event from COVID-19 vaccination. Further research into the hepatotoxic mechanism of COVID-19 vaccination is needed to better understand the adverse effects.


Disclosures:


Nada Saleh, MD, Sultan Ahmed, DO, Luqman Baloch, MD, Christine Junia, MD, Thayer Hamoudah, MD. P3016 - An Unexpected Cause of Liver Injury, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.