https://scholars.lib.ntu.edu.tw/handle/123456789/637301
標題: | Recovery from post-COVID-19 vaccination biliary ductopenia and multiorgan inflammation: A case with insight from angiotensin II type 1 receptor antibody- mediated injury | 作者: | Chang, Alan Jeng, Yung-Ming CHENG-MAW HO Lee, Po-Huang |
關鍵字: | angiotensin II type 1 receptor antibody;antibody-mediated injury;C4d;COVID-19;ductopenia;mRNA vaccine | 公開日期: | 15-五月-2023 | 來源出版物: | Research Square | 摘要: | Background The coronavirus disease 2019 (COVID-19) pandemic has caused significant morbidity and mortality. Spike messenger RNA (mRNA)–based vaccines against severe acute respiratory syndrome coronavirus 2 may contribute to immune-mediated injuries. Here we present a case of marked cholangiopathy with multiorgan injury and investigate the potential mechanisms associated with mRNA-based vaccines. Case summary and investigation A previously healthy 47-year-old man developed progressive jaundice 2 weeks after receiving his 3rd COVID-19 vaccination (1st mRNA-based vaccine). Apart from elevated serum total bilirubin levels (peaked at >70 mg/dL), deteriorating renal (blood urea nitrogen: peak, 108.5 mg/dL; creatinine: peak, 6 mg/dL) and exocrine pancreas (amylase: peak, 1717 U/L; lipase: peak, 5784 U/L) profiles were also seen. Vanishing bile duct syndrome characterized by ductopenia and cholangiocyte vacuolation, positive C4d deposition, and high titer of anti-angiotensin II type 1 receptor antibody consistently explain the overall antibody-mediated pathogenesis resembling antibody-mediated “rejection” in the solid organ transplant setting. Corticosteroids and plasmapheresis were administered, leading to gradual resolution of the symptoms, and the jaundice completely resolved 2 months later. Conclusion Here we reported a case of antibody-mediated multiorgan injury after an mRNA COVID-19 vaccine characterized by severe cholangiopathy. The patient recovered with corticosteroids and plasmapheresis, and long-term follow-up is needed. © 2023, CC BY. |
URI: | https://scholars.lib.ntu.edu.tw/handle/123456789/637301 | DOI: | 10.21203/rs.3.rs-2917943/v1 |
顯示於: | 醫學系 |
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