Acute Liver Failure Caused by Secondary Hemophagocytic Lymphohistiocytosis After COVID-19 Vaccination – Case Report and Literature Review

Abstract

Hemophagocytic lymphohistiocytosis (HLH) is a congenital or acquired hyperinflammatory syndrome, in some cases accompanied by acute liver failure. We present a case report of acute liver failure associated with HLH after COVID-19 vaccination and bring a literature review of the connection between HLH and COVID-19 vaccination. HLH has significant mortality rate, and liver transplantation is not a therapeutic option. Therefore, early recognition and timely conservative treatment are corner stones in reducing HLH-related morbidity and mortality.

Keywords:

• hemophagocytic lymphohistiocytosis
• acute liver failure
• COVID-19 vaccine
• multisystem inflammatory syndrome

Abbreviations

ALF, acute liver failure; ALT, alanine aminotransferase; AST, aspartate aminotransferase; ANA, antinuclear antibody; HLH, hemophagocytic lymphohistiocytosis; IL-1, interleukin 1; INR, international normalized ratio; MIS-C/A, multisystem inflammatory syndrome in children/adults; MIS-V, multisystem inflammatory response after vaccination; MSCT, multi-slice computed tomography; NK, natural killer cells; PF4, platelet factor 4; SARS-CoV-2, severe acute respiratory syndrome corona virus 2; sIL-2R, soluble interleukin 2 receptor; VITT, vaccine induced thrombotic thrombocytopenia; WH, West Haven.

Ethics

The patient signed informed consent, on the day of admission to hospital, regarding the use of their medical information for scientific purposes. Despite our best efforts to contact the patient’s next of kin for consent to publish, they are lost to follow-up. The Editor-in-Chief has approved the publication of this case based on COPE guidelines. Given information presented in this case report, institutional approval was not required to publish the case details.

Disclosure

The authors have no conflict of interest to declare for this work.