Hyperenzymemia after vaccination against COVID-19: complex equation with simple variables

The article presents clinical case of the jaundice development and severe hyperenzymemia in GAM-Covid-VAK (Sputnik V) vaccination against COVID-19 in a 69-year-old patient. History — systematic use of non-steroidal anti-inflammatory drugs due to persisting pain after knee arthroplasty in 2018; frequent trips for several years to another region for sanatorium treatment, the use of mineral water. The diseases caused by hepatitis viruses, drug damage and post-vaccination reaction were included in diagnostic search. The markers of hepatitis B and C infection viruses were not detected during the enzyme immunoassay and polymerase chain reaction. The indicator for determining the relationship of a drug with the liver damage development was 6 points (borderline value) and only indicated the likelihood of drug hepatotoxicity. At the same time, it is known from history that repeated administration of the drug did not cause liver dysfunctions. The diagnosis of coronavirus infection was established based on the identification of SARS-CoV-2 in the hospital with repeated laboratory testing and competing diagnosis of hepatitis A has been confirmed on the basis of hepatocellular damage and the presence of serological marker of hepatitis A virus (immunoglobulin M antibodies). The treatment was continued in the infectious hospital, where the diagnosis of co-infection was confirmed. The pneumofibrotic changes in the S5 region of the left lung were revealed according to computed tomography. The normalization of aminotransferase activity and bilirubin was noted during dynamic observation. Apparently HAV infection led to a decrease in the immune response, the formation of an insufficient level of neutralizing antibodies in vaccinated against COVID-19 patient M. and contributed to the development of a new coronavirus infection with minimal manifestations in contact with SARS-CoV-2.

1. Danan G., Teschke R. RUCAM in drug and herb induced liver injury: the update. International Journal of Molecular Sciences. 2016;17(1):14. doi: 10.3390/ijms17010014.

2. Sarialioglu F., Belen F. B., Hayran K. M. Hepatitis A susceptibility parallels high COVID-19 mortality. Turkish Journal of Medical Sciences. 2021;(51): 382-384. doi:10.3906/sag-2007-133.

3. COVID-19 pandemic on Diamond Princess. Available at: https://en.wikipedia.org/wiki/COVID-19_pandemic_on_Diamond_Princess (Access: 05/05/2020)

4. Sarialioglu F., Belen Apak F. B., Haberal M. Can Hepatitis A Vaccine Provide Protection Against COVID-19? Experimental and Clinical Transplantation. 2020;(2):141-143. doi: 10.6002/ect.2020.0109.

5. Ilchenko L. Yu., Nikitin. I. G., Fedorov I. G. COVID-19 and Liver Damage. Th e Russian Archives of Internal Medicine. 2020;10(3):188-197. (in Russ.) doi: 10.20514/2226-6704-2020-10-3-188-197.

6. Zhang C., Shi L., Wang F.-S. Liver injury in COVID-19: management and challenges. Lancet Gastroenterol. Hepatol. 2020;5(5):428-430. doi: 10.1016/S2468-1253(20)30057-1.

7. Jarynowski A., Semenov A., Kaminski M., Belik V. Sputnik V Vaccine in Russia: Social Media Content Analysis of Telegram via Deep Learning. Journal of Medical Internet Research. Sep. 28 2021. doi: 10.2196/30529.

8. Johns Hopkins University & Medicine. Coronavirus Resource Centre [Internet]. Available at: https://coronavirus.jhu.edu/map.html (Access: 05.05.2020)

9. BBC News [Coronavirus: Swiss cheese as a model in the fight against Covid-19 (and why holes get in the way)]. (in Russ.) Available at: https://www.bbc.com/russian/features-55221727 (Access: 05.05.2020).

10. tedmood.ru/russian/resources/idt-40ac92b1-1750-4e86-9936-2cda6b0acb3f (Access: 05.05.2020)

11. Bozio C. H., Grannis S. J., Allison L. et al. Naleway, Laboratory-Confirmed COVID-19 Among Adults Hospitalized with COVID-19-Like Illness with Infection-Induced or mRNA Vaccine-Induced SARS-CoV-2 Immunity - Nine States, January-September 2021. Morbidity and Mortality Weekly Report. 2021;70(44):1539-1544. doi: 10.15585/mmwr.mm7044e1

12. [Coronavirus vaccination statistics in Russia as of November 23, 2021]. (in Russ.) Available at: https://statistika-vakcinacii.ru/statistika-vakcinacii-ot-koronavirusa-v-rossii-na-23-noyabrya-2021-goda (Access: 05.05.2020)