S3098 Vanishing Bile Duct Syndrome in the Setting of Newly Diagnosed Hodgkin Lymphoma

Abstract

These values were a significant increase from normal the month before. This necessitated up-titration of prednisone and MMF, which normalized her liver enzymes within two months. A 67-year-old female with a past medical history of hypothyroidism was found to have elevated liver enzymes associated with fatigue. Further lab work-up and liver biopsy revealed autoimmune hepatitis. This patient's autoimmune hepatitis was controlled on a regimen of prednisone and MMF for six months. However, three weeks after receiving the third COVID Pfizer vaccine, this patient's labs exhibited AST: 99 and ALT: 105. These values were a significant increase from normal the month before. Her immunosuppressants were up-titrated with an increase in MMF and the addition of cyclosporine. Her labs improved to AST: 73 and ALT: 87 within two months. Discussion: These cases demonstrate that COVID vaccination may play a role in autoimmune hepatitis flares. This can be a challenging situation for many clinicians to navigate, as COVID remains a significant threat to patients' health, and there are many case reports that show that COVID infection itself can precede a flare. Patients with autoimmune liver disease may benefit from closer laboratory evaluation surrounding COVID vaccination.