SARS-CoV-2 Vaccine-Related Liver Failure: Active Hepatitis B and Comprehensive Literature Analysis

Abstract

SARS-CoV-2 infection or vaccination is closely associated with liver injury, and autoimmune hepatitis episodes have been described, but liver failure has not been reported. Here, we report the case of a 41-year-old man, presenting with fatigue, anorexia after activity, greasy, decreased intake, yellow urine, and occasionally acid reflux in the stomach, occurring 2–3 weeks after receiving the first dose of inactivated SARS-CoV-2 vaccination, thought to be associated with his underlying chronic hepatitis B and fatty liver condition. The patient took the drug irregularly and did not achieve viral conversion to negative and appear rtA181T-resistant HBV mutation. Recently, the laboratory results showed abnormal liver function with high alanine aminotransferase (ALT), aspartate aminotransferase (AST), and γ-glutamyl transferase (GGT), and there was no improvement in liver function after hepatoprotective therapy, and the serum hepatitis B virus (HBV) concentration was greater than 2.0 × 106 IU/mL. Later, after being admitted to our hospital, it was found that he was in, malaise, jaundice, his eyes and sclera were yellow, his lungs were coarse breath sounds, his liver function was abnormally elevated, and his HBV virus developed a drug-resistant mutation. He has no history of autoimmune disease and tests negative for autoimmune antibodies. He became severely ill after intermittently stopping HBV treatment, worsened liver injury after inactivated SARS-CoV-2 vaccination, and was diagnosed with acute-on-chronic liver failure (ACLF). By summarizing the case report, it will provide important information on the vaccine safety assessment of vaccine components, immunization routes, and dosage for people with underlying liver disease.