Clue to the Cause of 'Liver Dysfunction' Occurring After COVID-19 Vaccination Revealed

Seoul St. Mary's Hospital Professors Seong Pil-su and Incheon St. Mary's Hospital Professor Lee Soon-gyu Team
First Domestic Case of Vaccine-Induced Inflammatory Autoimmune Interstitial Lung Disease

Professor Seong Pil-su (left), Department of Gastroenterology, Seoul St. Mary's Hospital, and Professor Lee Soon-gyu, Department of Gastroenterology, Incheon St. Mary's Hospital.

[Asia Economy Reporter Lee Gwan-ju] The clue to liver function abnormalities occurring after COVID-19 vaccination has been uncovered by domestic researchers.

The research team led by Professors Seong Pil-su from the Department of Gastroenterology at Seoul St. Mary's Hospital, The Catholic University of Korea, and Lee Soon-gyu from the Department of Gastroenterology at Incheon St. Mary's Hospital announced on the 1st that liver biopsy results of patients vaccinated against COVID-19 demonstrated the expression of T cells that cause autoimmune liver diseases.

This study is the first domestic case supporting the groundbreaking research results published last April by the University of Freiburg in Germany, which stated that "specific CD8+ T cells after COVID-19 vaccination induce liver damage, potentially causing autoimmune liver diseases." Notably, the overlap syndrome, where autoimmune hepatitis and primary biliary cholangitis occur simultaneously after vaccination, is the world's first reported case.

The patient was a 57-year-old woman with no history of underlying diseases, alcohol consumption, or liver disease medication, who was referred to Seoul St. Mary's Hospital due to general weakness. Two weeks after the first COVID-19 vaccine dose, she experienced fatigue and overall weakness and visited the hospital. Physical examination results were normal. Although her liver function levels were normal during regular health check-ups, blood tests conducted during this visit showed elevated liver markers indicative of liver disease.

Tests conducted to differentiate the cause showed negative results for viral hepatitis, and no abnormalities were found in liver ultrasound. However, autoimmune antibody tests revealed positive antinuclear antibodies and antimitochondrial antibodies, confirming a high possibility of autoimmune liver disease, including overlap syndrome.

Subsequently, liver biopsy results showed immune cells, specifically T cells, concentrated in the portal vein area causing infiltration and necrosis of liver tissue. Additionally, plasma cell infiltration, piecemeal necrosis, and inflammation and necrosis of the portal vein extending to the periportal area were observed, indicating interface hepatitis and non-suppurative cholangitis. These findings confirmed the diagnosis of overlap syndrome, where autoimmune hepatitis and primary biliary cholangitis progress simultaneously as subtypes of autoimmune liver disease.

The patient met the diagnostic criteria for overlap syndrome and recovered to normal liver function levels within two weeks after appropriate treatment, including high-dose ursodeoxycholic acid (UDCA). Professor Lee Soon-gyu emphasized, “This study is significant as it provides clues to the mechanism by which immune responses after vaccination can cause liver damage and liver function abnormalities,” adding, “It is important to differentiate and treat this condition through detailed medical history and examinations during patient care.”

This study was reported in the Journal of Hepatology, the most prestigious international journal in the field of hepatology.

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