Increased incidence of seronegative autoimmune hepatitis in children during SARS-CoV-2 pandemia period
Résumé
Background Seronegative autoimmune hepatitis in children is a rare but potentially severe disease, sometimes requiring liver transplantation. This type of hepatitis may be associated with various immunological and hematological disorders, ranging from isolated lymphopenia to aplastic anemia. Precise pathophysiological mechanisms are still unknown, but the role of viruses cannot be excluded, either as directly pathogenic or as triggers, responsible for an inappropriate immune stimulation. Having the impression of an increasing number of seronegative autoimmune hepatitis since the beginning of SARS-CoV-2 pandemia period, we hypothesized that SARS-CoV-2 virus could be an infectious trigger. Methods We conducted a retrospective, observational, descriptive study about children with seronegative autoimmune hepatitis, in a tertiary care center, between 2010 and 2022. Results Thirty-two patients were included. The overall incidence of seronegative autoimmune hepatitis increased 3.3-fold in 2020-2022, during the SARS-CoV-2 pandemia period (16 patients in 2.8 years) compared with 2010-2019 the pre pandemia period (16 patients in 9 years). Patients’ clinical and biochemical liver characteristics did not differ between the two periods. Hematological damages were less severe during the pandemia period. Immunological studies revealed a dysregulated immune response. The initiation of immunosuppressive therapy (corticosteroids ± cyclosporine) was earlier during the pandemia period than before. Conclusion In cases of undetermined acute hepatitis, an immune-mediated origin should be considered, prompting a liver biopsy. If the histological aspect points to an immune origin, immunosuppressive treatment should be instituted even though autoimmune hepatitis antibodies are negative. Close hematological monitoring must be performed in all cases. The 3.3-fold increase of cases during the SARS-CoV-2 pandemia will need to be further analyzed to better understand the underlying immunological mechanisms, and to prove its potential involvement.
Mots clés
GGT
gamma-glutamyl transpeptidase
Hb
hemoglobin
HSCT
hematopoietic stem cell transplantation
Ig
immunoglobulin
LT
liver transplantation
LTd
liver transplanted patients
MRI
magnetic resonance imaging
PCR
polymerase chain reaction
PT
prothrombin time
PR
partial remission
SARS-CoV-2
Severe Acute Respiratory Syndrome Coronavirus 2
SAIH
AA
aplastic anemia ALT
alanine aminotransferase ALF
acute liver failure AST
aspartate aminotransferase ATG
Antithymocyte Globulin BMA/B
bone marrow aspiration/biopsy CMV
cytomegalovirus CR
complete remission EBV
Epstein-Barr virus FV
coagulation factor V GGT
gamma-glutamyl transpeptidase Hb
hemoglobin HSCT
hematopoietic stem cell transplantation Ig
immunoglobulin LT
liver transplantation LTd
liver transplanted patients MRI
magnetic resonance imaging PCR
polymerase chain reaction PT
prothrombin time PR
partial remission SARS-CoV-2
Severe Acute Respiratory Syndrome Coronavirus 2 SAIH
Seronegative autoimmune hepatitis WHO
World Health Organization pediatric seronegative autoimmune hepatitis
aplastic anemia
severe acute respiratory syndrome coronavirus 2
dysimmunity
immunosuppressive treatment
ALT
alanine aminotransferase
ALF
acute liver failure
AST
aspartate aminotransferase
ATG
Antithymocyte Globulin
BMA/B
bone marrow aspiration/biopsy
CMV
cytomegalovirus
CR
complete remission
EBV
Epstein-Barr virus
FV
coagulation factor V
Domaines
Sciences du Vivant [q-bio]
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https:pmc.ncbi.nlm.nih.gov:articles:PMC11425678:pdf:fimmu-15-1445610.pdf (1.15 Mo)
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