Midwestern University, Mountain Vista Medical Center Mesa, AZ, United States
Preeyanka Sundar, MD, MPH1, Suma Harsha Kosuru, MBBS2, Matthew Hillam, DO1, Tushar Gohel, MD, CNSC3 1Midwestern University, Mountain Vista Medical Center, Mesa, AZ; 2Mountain Vista Medical Center, Aldie, VA; 3Reddy GI Associates, Gilbert, AZ; Midwestern University, Mountain Vista Medical Center, Mesa, AZ
Introduction: This case highlights an atypical hepatic pathology after the COVID 19 vaccine and is an important contribution to the literature given the newness of the vaccine.
Case Description/Methods: A 34-year-old male with no significant past medical history presented after his first COVID 19 vaccine with headaches, fevers up to 39C and myalgias 5 days after his vaccine. No recent travel or drugs. Labs revealed Hb 10.8, T-bilirubin peaked to 4.6, admitted with T bilirubin 3.7, D bilirubin 2.5, AST 364, ALT 377, ALP 230, V lac 1.3, Chronic liver work up A1AT, Ceruloplasmin, IgG, ANA, AMA, EBV, CMV IgM unremarkable, only ASMA mildly positive 1:20. Antibiotics were initiated and blood, urine cultures, HIV, respiratory panel, Covid, hepatitis panel were negative. HIDA, US and CT abdomen showed normal spleen and liver size. For headaches, CT and MRI brain were unremarkable. Peripheral blood leukemia-lymphoma panel showed an inversion of CD4/CD8 ratio, a nonspecific finding in viral and reactive processes. Liver biopsy showed atypical CD8-positive T cell population identified in sinusoids (focal clustering, irregular membrane contour). Findings of undetermined significance and can be related to drug were determined to be related to his recent COVID 19 vaccination.
Discussion: His differentials included viral etiology or autoimmune liver disease due to activation of immune system from COVID-19 vaccine; labs and biopsy pointed toward liver pathology related to vaccination.
Disclosures: Preeyanka Sundar indicated no relevant financial relationships. Suma Harsha Kosuru indicated no relevant financial relationships. Matthew Hillam indicated no relevant financial relationships. Tushar Gohel indicated no relevant financial relationships.
Preeyanka Sundar, MD, MPH1, Suma Harsha Kosuru, MBBS2, Matthew Hillam, DO1, Tushar Gohel, MD, CNSC3. P1865 - An Atypical Occurrence: Liver Pathology Related to the COVID-19 Vaccination, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.