Recurrent hepatic flares after SARS-CoV-2 vaccination in a patient with erythropoietic protoporphyria: A case report

Abstract

Erythropoietic protoporphyria (EPP) is a rare genetic disorder that can lead to liver complications in a subset of patients. We describe the case of a 36-year-old woman with genetically confirmed EPP who developed acute liver injury following the second and booster doses of the Pfizer-BioNTech SARS-Cov-2 vaccine. The clinical course included elevated liver enzymes and PPIX levels, thrombocytopenia, reactivation of autoimmune markers, and worsening liver stiffness. No other causes were identified. Statistical analysis confirmed significant biochemical changes post-vaccination. This case suggests a possible immune-mediated hepatic response triggered by vaccination in a genetically predisposed individual.