Unprecedented case of rapid-onset autoimmune hepatitis triggered by COVID-19 mRNA vaccination, complicated by concurrent severe hemophagocytic lymphohistiocytosis and acute liver failure in a previously healthy adult: a multidisciplinary approach and review of therapeutic interventions.

Abstract

A previously healthy 35-year-old male developed acute autoimmune hepatitis 5 weeks after receiving his second dose of an mRNA vaccine, presenting with jaundice, elevated liver enzymes, and abdominal pain. The condition rapidly progressed to severe hemophagocytic lymphohistiocytosis (HLH) and acute liver failure, confirmed by liver biopsy and bone marrow aspirate. Despite aggressive multidisciplinary treatment, including corticosteroids, immunoglobulin, and IL-1 antagonists, the patient deteriorated, developing multi-organ failure. Emergency liver transplantation was considered but was not viable due to his unstable condition. The case highlights a potential rare vaccine-associated immune response which we believe has not been reported in the literature, requiring prompt recognition and multidisciplinary management. Further research is needed to understand the underlying immunogenic triggers and optimize treatment.