Case ReportFree Access

Development of hepatitis triggered by SARS-CoV-2 vaccination in patient with cancer during immunotherapy: a case report

*Author for correspondence: Tel.: +39 038 250 2287;

Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, 27100, Italy

Department of Internal Medicine, Clinica Medica, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, 27100, Italy

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Irene Cassaniti

Department of Microbiology & Virology, Molecular Virology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, 27100, Italy

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Paolo Sacchi

Division of Infectious Diseases I, Fondazione IRCCS Policlinico San Matteo, Pavia, 27100, Italy

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Published Online:13 Jun 2022https://doi.org/10.2217/imt-2021-0342

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Abstract

Patients with cancer have a higher risk of severe COVID-19, and expert consensus advocates for COVID-19 vaccination in this population. Some cases of autoimmune hepatitis have been described after the administration of COVID-19 vaccine in the people in apparently good health. Immune checkpoint inhibitors (ICIs) are responsible for a wide spectrum of immune-related adverse events (irAEs). This article reports a case of hepatitis and colitis in a 52-year-old woman who was undergoing immunotherapy and was HBV positive 10 days after receiving the first Pfizer-BioNTech COVID-19 vaccine dose. Because both ICIs and the COVID-19 vaccines stimulate the immune response, the authors hypothesize that these vaccines may increase the incidence of irAEs during ICI treatment. There is a complex interplay between the immune-mediated reaction triggered by the vaccination and PD-L1 co-administration.

Plain language summary

Patients with cancer have a higher risk of severe COVID-19, and expert consensus advocates for COVID-19 vaccination in this population. Some reports have described autoimmune hepatitis after the administration of COVID-19 vaccine. It is difficult, however, to establish a causal relationship between COVID-19 vaccination and autoimmune hepatitis. This article reports a case of hepatitis and colitis in a 52-year-old woman with lung cancer who was undergoing immunotherapy and was was found to be HBV positive 10 days after her first Pfizer-BioNTech COVID-19 vaccine dose. Because both immunotherapy and COVID-19 vaccines stimulate the immune response, the authors hypothesize that these vaccines may increase the incidence of immune-related side effects.

Tweetable abstract

A complex interplay between the immune-mediated reaction triggered by mRNA #COVID19 vaccination and #PDL1 coadministration may rarely occur in patients with cancer during #immunotherapy

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Papers of special note have been highlighted as: • of interest

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Vol. 14, No. 12

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History

Received 16 December 2021

Accepted 12 May 2022

Published online 13 June 2022

Published in print August 2022

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Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants, or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

Written informed consent was obtained from the patient for publication of this case report and any accompanying laboratory findings. The article describes a case report, and therefore, no additional permission from the authors’ ethics committee was required.

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