Elsevier

Clinical Immunology

Volume 245, December 2022, 109138
Clinical Immunology

Immunological characteristics of severe acute hepatitis of unknown origin in a child post SARS-CoV-2 infection

https://doi.org/10.1016/j.clim.2022.109138Get rights and content

Highlights

  • Immunophenotypic analyses of severe acute hepatitis in a child post SARS-CoV-2 infection were performed.

  • Autoimmune hepatitis-like liver histology with inflammatory cells predominantly composed of CD8+ lymphocytes was observed.

  • Remarkable peripheral CD8+ T-cell activation with a skewed T cell receptor repertoire was observed.

  • Elevated serum levels of anti-SARS-CoV-2 spike IgG antibodies peaked after treatment was observed.

Abstract

Recent studies have reported that pediatric acute liver failure of unknown origin is immune-mediated, with CD8+ T cells playing a key role. Moreover, investigation of superantigen-mediated T-cell activation by the SARS-CoV-2 spike protein in pediatric severe acute hepatitis is needed in the context of the proposed mechanism of multisystem inflammatory syndrome in children (MIS-C). We investigated the immunological characteristics of a Japanese pediatric patient with severe acute hepatitis post SARS-CoV-2 infection. The patient demonstrated autoimmune hepatitis-like liver histology with CD8+ lymphocyte-predominant infiltration. There was Th1-type immune skewing, including remarkable peripheral CD8+ T-cell activation and a skewed T cell receptor repertoire. We also found elevated plasma levels of the anti-SARS-CoV-2 spike-specific IgG antibody, and the titer peaked after treatment, as seen with MIS-C. These findings support that immunological activation involving SARS-CoV-2 spike protein plays a crucial role in a pediatric patient with acute severe hepatitis post SARS-CoV-2 infection.

Keywords

Autoimmune hepatitis
COVID-19
Cytokine
Multisystem inflammatory syndrome in children
Superantigens
T-cell receptor

Abbreviations

COVID-19
coronavirus disease-2019
IL
Interleukin
MIS-C
multisystem inflammatory syndrome in children
MCP-1
monocyte chemoattractant protein-1
PCR
polymerase chain reaction
SARS-CoV-2
severe acute respiratory syndrome coronavirus 2
WHO
World Health Organization

Data availability

Data will be made available on request.

Cited by (0)

1

These authors contributed equally.

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