Autoimmune Hepatitis-Like Liver Injury after COVID-19 Vaccination; Review of Molecular Underpinnings and Clinicopathologic Picture

Mass vaccination against COVID-19 infection has been able to substantially alleviate the consequent mor-talities and the spread of the disease. The paced design and administration of novel mRNA-based vaccinespaved the way for the production against cancers and acquired immunodeficiency syndrome. Various sideeffects, lethal in some instances, are described for COVID-19 vaccines, including the instigation of inci-dence or relapse of autoimmune disorders, including autoimmune hepatitis (AIH). Molecular mimicry withthe spike protein S1 and cross-reactions, adjuvants-induced autoimmune/autoinflammatory syndrome,epitope spreading, and bystander activation are among the molecular mechanisms that are hypothesized tomediate vaccine-induced autoimmunity. Pathological and serologic evaluations of patients with liver injuryfollowing COVID-19 vaccination have displayed that most cases can be categorized as probable or definitefor the diagnosis of AIH. AIH and AIH-like liver injuries following COVID-19 vaccination are generallymanageable with the administration of corticosteroids and other immunosuppressive therapies if required.Data on the safety of subsequent vaccination is scarce; however, vaccination during maintenance therapywith steroids seems safe. More importantly, the recognition of asymptomatic cases with altered liver ami-notransferase levels necessitates the design of prospective cohorts to assess the long-term consequences ofsub-clinical liver dysfunction induced by COVID-19 vaccines.