24 aprile 2022

Epatite autoimmune dopo il vaccino COVID-19 ► Più di una coincidenza

Abstract

La pandemia di COVID-19 sta ancora imperversando in tutto il mondo e ci si aspetta che la vaccinazione ci porti fuori da questa pandemia. Sebbene l'efficacia dei vaccini sia fuori discussione, la sicurezza rimane ancora una preoccupazione.

Riportiamo un caso di una donna di 65 anni che ha sperimentato un'epatite autoimmune acuta grave due settimane dopo aver ricevuto la prima dose di vaccino Moderna-COVID-19. L'immunoglobulina G del siero era elevata e l'anticorpo antinucleare era positivo (1:100, modello maculato). L'istologia epatica ha mostrato una marcata espansione dei tratti portali, una grave epatite di interfaccia e molteplici focolai confluenti di necrosi lobulare. Ha iniziato il trattamento con prednisolone, con un'evoluzione clinica e analitica favorevole.

Alcuni rapporti recenti hanno suggerito che la vaccinazione COVID-19 può portare allo sviluppo di malattie autoimmuni. Si ipotizza che il vaccino possa disturbare l'autotolleranza e innescare risposte autoimmuni attraverso la cross-reattività con le cellule dell'ospite. Pertanto, gli operatori sanitari devono rimanere vigili durante la vaccinazione di massa COVID-19.
Ci sono state alcune preoccupazioni riguardo alla possibilità di autoimmunità indotta dal vaccino COVID-19 [1]. Il mimetismo molecolare è stato suggerito come un potenziale meccanismo per questa associazione. Infatti, gli anticorpi contro la proteina spike S1 della SARS-CoV-2 avevano un'alta affinità contro alcune proteine dei tessuti umani [2]. Poiché l'mRNA dei vaccini codifica la stessa proteina virale, essi possono scatenare malattie autoimmuni in pazienti predisposti.

Riportiamo il caso di una donna di 65 anni, con policitemia vera JAK2 V617F-positiva diagnosticata nel 2006, sotto interferone pegilato dal 2019. I suoi farmaci di routine comprendevano anche acido acetilsalicilico 100 mg/giorno, sertralina 25 mg/giorno ed esomeprazolo 20 mg/giorno per oltre due anni. Non aveva un'anamnesi di malattia epatica ed era nota per avere test epatici di routine normali (AST 28U/L, ALT 24U/L, GGT 24U/L, ALP 108U/L, bilirubina totale 0,72 mg/dL). Inoltre, non aveva una storia personale o familiare di malattia autoimmune.

Dopo aver ricevuto la prima dose di vaccino Moderna-COVID-19, la paziente ha presentato un lieve dolore addominale. Due settimane dopo, i test di routine della funzionalità epatica hanno mostrato AST 1056U/L, ALT 1092U/L, GGT 329U/L, ALP 24U/L, bilirubina totale 1,14 mg/dL. La conta completa delle cellule del sangue e il rapporto internazionale normalizzato erano normali. Ha negato cambiamenti recenti nella terapia farmacologica. La sierologia per il virus dell'epatite A, il virus dell'immunodeficienza umana, il citomegalovirus, il virus di Epstein-Barr e il virus herpes simplex di tipo 1 e 2 erano tutti negativi. Anche la reazione a catena della polimerasi per i virus dell'epatite B, C ed E era negativa. I test della ceruloplasmina, dell'alfa-1 antitripsina e del ferro erano normali, così come la funzione tiroidea. L'anticorpo antinucleare era positivo (1:100, pattern maculato), rilevato tramite un test di immunofluorescenza indiretta su cellule HEP-20-10/fegato di scimmia (diluizione iniziale 1/100; diluizione finale 1/1000). Gli anticorpi anti-mitocondri, anti-muscolo liscio, anti-fegato-microsomiale, anti-gene epatico solubile e antineutrofili citoplasmatici erano tutti negativi. A questo punto, i livelli sierici di IgA, IgM e IgG erano normali. L'ecografia addominale Doppler ha mostrato epatomegalia senza morfologia cirrotica e nessuna dilatazione biliare o trombosi.

Cinque settimane dopo la vaccinazione, il paziente si è presentato con ittero e coluria. Il profilo epatico stava peggiorando e i livelli di IgG erano ora elevati (Fig. 1). Il paziente è stato ricoverato per la gestione clinica. È stata eseguita una biopsia epatica percutanea, che ha rivelato una marcata espansione dei tratti portali dovuta a un denso infiltrato infiammatorio, con aggregati di plasmacellule; sono stati osservati anche una grave epatite di interfaccia e molteplici focolai confluenti di necrosi lobulare (Fig. 2).

Il punteggio dei criteri diagnostici semplificati dell'International Autoimmune Hepatitis Group era 8 [diagnosi definitiva di epatite autoimmune (AIH)]. Il trattamento con prednisolone 60 mg/giorno è stato iniziato con un rapido miglioramento dei test di funzionalità epatica e la normalizzazione dei livelli di IgG. Un mese dopo la diagnosi iniziale, il paziente continua a stare bene con un ciclo decrescente di corticosteroidi.

Recentemente, sono stati riportati alcuni casi di AIH che si sono sviluppati dopo la vaccinazione COVID-19 [3,4]. Ci sono alcune somiglianze tra i casi precedentemente descritti e il presente caso, come un breve intervallo tra la vaccinazione e la comparsa dei sintomi [3]. Anche se il nostro paziente ha ricevuto il vaccino Moderna mRNA, ci sono già altre segnalazioni di AIH indotta dai vaccini Pfizer-BioNTech e Oxford-AstraZeneca, sostenendo l'idea che il vaccino COVID-19 scatena fenomeni autoimmuni indipendentemente dal suo meccanismo d'azione [4].

A differenza di altri casi, la nostra paziente non aveva fattori confondenti come la gravidanza o condizioni autoimmuni [3,4]. Tuttavia, era in trattamento con interferone pegilato per la policitemia vera. Infatti, questo farmaco è stato collegato all'induzione di condizioni autoimmuni, tra cui l'AIH [5]. Tuttavia, questo effetto collaterale insorge di solito entro 1-2 mesi dall'inizio della terapia e il nostro paziente aveva già iniziato l'interferone pegilato da oltre due anni. Inoltre, la tempistica del danno epatico, l'ampia esclusione di altre cause di malattia epatica e la normalizzazione dei test di funzionalità epatica e dei livelli di IgG dopo il trattamento, rendono molto probabile che l'AIH sia stata scatenata dalla vaccinazione COVID-19.

Solo il follow-up a lungo termine potrà confermare se la vaccinazione COVID-19 aumenta il rischio di AIH. Tuttavia, non dovrebbe distrarre gli operatori sanitari dai benefici schiaccianti della vaccinazione COVID-19 di massa.

Fonte: https://www.sciencedirect.com/science/article/pii/S0896841121001499?via%3Dihub

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1100029325, RESELLER, 07bcf65f187117b4 smaato.com, 1100044045, RESELLER, 07bcf65f187117b4 smaato.com, 1100047713, RESELLER, 07bcf65f187117b4 smartadserver.com, 1408, RESELLER smartadserver.com, 1827, RESELLER smartadserver.com, 2058, RESELLER smartadserver.com, 2161, RESELLER smartadserver.com, 2441, RESELLER smartadserver.com, 2491, RESELLER smartadserver.com, 2640, RESELLER smartadserver.com, 2883, RESELLER smartadserver.com, 3050, RESELLER smartadserver.com, 3296, RESELLER, 060d053dcf45cbf3 smartadserver.com, 3554, RESELLER smartadserver.com, 3668, RESELLER smartadserver.com, 3713, RESELLER smartadserver.com, 3785, RESELLER smartadserver.com, 4012, RESELLER smartadserver.com, 4016, RESELLER smartadserver.com, 4071, RESELLER smartadserver.com, 4073, RESELLER smartadserver.com, 4074, RESELLER smartadserver.com, 4111, RESELLER smartadserver.com, 4537, RESELLER, 060d053dcf45cbf3 smartclip.net, 11958, RESELLER smartstream.tv, 6459, RESELLER smilewanted.com, 2246, RESELLER smilewanted.com, 2825, RESELLER sonobi.com, 7b37f8ccbc, RESELLER, d1a215d9eb5aee9e sonobi.com, 83729e979b, RESELLER soundcast.fm, 5e3301babc6b5, RESELLER soundcast.fm, 63038ce281dfc, RESELLER sovrn.com, 257611, RESELLER, fafdf38b16bf6b2b sovrn.com, 260380, RESELLER, fafdf38b16bf6b2b sovrn.com, 308272, RESELLER, fafdf38b16bf6b2b sovrn.com, 310770, RESELLER, fafdf38b16bf6b2b sovrn.com, 327078, RESELLER, fafdf38b16bf6b2b sovrn.com, 346012, RESELLER, fafdf38b16bf6b2b sovrn.com, 397546, RESELLER, fafdf38b16bf6b2b spotim.market, 4446666, RESELLER, 077e5f709d15bdbb spotx.tv, 146631, RESELLER, 7842df1d2fe2db34 spotx.tv, 153598, RESELLER, 7842df1d2fe2db34 spotx.tv, 178357, RESELLER, 7842df1d2fe2db34 spotx.tv, 202009, RESELLER, 7842df1d2fe2db34 spotx.tv, 230037, RESELLER, 7842df1d2fe2db34 spotx.tv, 244525, RESELLER, 7842df1d2fe2db34 spotxchange.com, 146631, RESELLER, 7842df1d2fe2db34 spotxchange.com, 153598, RESELLER, 7842df1d2fe2db34 spotxchange.com, 178357, RESELLER, 7842df1d2fe2db34 spotxchange.com, 202009, RESELLER, 7842df1d2fe2db34 spotxchange.com, 230037, RESELLER, 7842df1d2fe2db34 spotxchange.com, 244525, RESELLER, 7842df1d2fe2db34 sublime.xyz, 2031, RESELLER supply.colossusssp.com, 194, RESELLER, 6c5b49d96ec1b458 synacor.com, 82171, RESELLER, e108f11b2cdf7d5b targetspot.com, 291, RESELLER, feb28ed826dcf532 teads.tv, 14211, RESELLER, 15a9c44f6d26cbe1 themediagrid.com, BQ9PNM, RESELLER, 35d5010d7789b49d themediagrid.com, ERS3KO, RESELLER, 35d5010d7789b49d themediagrid.com, JALYWI, RESELLER, 35d5010d7789b49d themediagrid.com, OWYXGT, RESELLER, 35d5010d7789b49d themediagrid.com, PIFK3H, RESELLER, 35d5010d7789b49d themediagrid.com, UI4ZER, RESELLER, 35d5010d7789b49d tremorhub.com, 0cc6w-h2tvh, RESELLER, 1a4e959a1b50034a tremorhub.com, 0cc6w-stphr, RESELLER, 1a4e959a1b50034a tremorhub.com, ewut4-b6zwq, RESELLER, 1a4e959a1b50034a triplelift.com, 10521, RESELLER, 6c33edb13117fd86 triplelift.com, 13567, RESELLER, 6c33edb13117fd86 triplelift.com, 2792, RESELLER, 6c33edb13117fd86 triplelift.com, 8495, RESELLER, 6c33edb13117fd86 triplelift.com, 9979, RESELLER, 6c33edb13117fd86 tritondigital.com, 106423, RESELLER, 19b4454d0b87b58b tritondigital.com, 123193, RESELLER, 19b4454d0b87b58b tritondigital.com, 44733, RESELLER, 19b4454d0b87b58b verve.com, 15503, RESELLER, 0c8f5958fc2d6270 vi.ai, 987349031605160, RESELLER video.unrulymedia.com, 1767448067723954599, RESELLER video.unrulymedia.com, 2564526802, RESELLER video.unrulymedia.com, 3948367200, RESELLER video.unrulymedia.com, 609241817, RESELLER video.unrulymedia.com, 7491264956381456664, RESELLER vidoomy.com, 2252369, RESELLER viralize.com, 339, RESELLER viralize.com, 3828, RESELLER voicemediagroup.com, 1554, RESELLER xad.com, 958, RESELLER, 81cbf0a75a5e0e9a xandr.com, 10736, RESELLER xandr.com, 14674, RESELLER, f5ab79cb980f11d1 xandr.com, 4009, RESELLER, f5ab79cb980f11d1 yahoo.com, 49648, RESELLER yahoo.com, 57289, RESELLER, e1a5b5b6e3255540 yahoo.com, 57857, RESELLER, e1a5b5b6e3255540 yahoo.com, 58578, RESELLER, e1a5b5b6e3255540 yahoo.com, 58905, RESELLER, e1a5b5b6e3255540 yahoo.com, 59040, RESELLER, e1a5b5b6e3255540 yahoo.com, 59244, RESELLER yahoo.com, 59361, RESELLER, e1a5b5b6e3255540 yahoo.com, 59531, RESELLER, e1a5b5b6e3255540 yahoo.com, 59702, RESELLER, e1a5b5b6e3255540 yahoo.com, 59973, RESELLER, e1a5b5b6e3255540 yieldlab.net, 2172218, RESELLER yieldlab.net, 227224, RESELLER yieldlab.net, 495507, RESELLER yieldlab.net, 506261, RESELLER yieldlab.net, 5494672, RESELLER yieldlab.net, 5798882, RESELLER yieldlab.net, 6374282, RESELLER yieldlab.net, 6378054, RESELLER # END ads.txt - vocidallastrada.org - 2023-10-18 14:39:45