Does receiving the BNT COVID-19 vaccine cause abnormal ALT liver enzyme levels?
Hello Doctor: I have been diagnosed with autoimmune conditions including Sjögren's syndrome, autoimmune thyroiditis, and vitiligo, and I have been taking the medication Sulfasalazine.
Since last July, I have been experiencing severe skin itching, especially at night, which has affected my sleep.
Additionally, I am under significant work stress and plan to resign by the end of the year.
In April of this year, my ALT/AST levels were 13; in October, they were ALT 20/AST 22; however, in December, my ALT level was abnormally high at 77 (this is the first time it has been abnormal).
I do not have hepatitis B or fatty liver disease, and an ultrasound in September showed no issues.
I received my first dose of the BNT COVID-19 vaccine on September 29 and the second dose on November 5.
My liver function tests have always been normal until now.
Could this abnormality be caused by the COVID-19 vaccine, or is it possible that it is related to autoimmune hepatitis?
Yuping, 40~49 year old female. Ask Date: 2021/12/17
Dr. Yang Zhichao reply Gastroenterology and Hepatology
Hello Miss Yuping: Based on what you mentioned, it should not be related to the vaccine.
I believe it is more associated with autoimmune diseases.
You may want to discuss this with a rheumatologist.
Reply Date: 2021/12/17
More Info
The question of whether the BNT COVID-19 vaccine can cause abnormal ALT (alanine aminotransferase) levels in patients is a complex one, particularly in the context of pre-existing autoimmune conditions. Based on the information provided, it appears that the patient has a history of autoimmune diseases, including Sjögren's syndrome, autoimmune thyroiditis, and vitiligo, which can complicate the interpretation of liver enzyme levels.
Firstly, it is important to understand what ALT levels indicate. ALT is an enzyme primarily found in the liver, and elevated levels can indicate liver inflammation or damage. In the context of the COVID-19 vaccine, there have been reports of transient liver enzyme elevations following vaccination, but these are generally mild and resolve without intervention. The Centers for Disease Control and Prevention (CDC) and other health organizations have not established a direct causal link between the COVID-19 vaccines and significant liver enzyme elevations.
In your case, the ALT level of 77 is indeed elevated compared to your previous readings, but it is essential to consider the broader context. The fact that you have a history of autoimmune conditions raises the possibility that your elevated ALT could be related to autoimmune hepatitis or another autoimmune process rather than the vaccine itself. Autoimmune hepatitis can occur in individuals with other autoimmune diseases, and it is characterized by elevated liver enzymes and inflammation of the liver.
Moreover, stress and other factors, such as medications or lifestyle changes, can also contribute to fluctuations in liver enzyme levels. The stress you mentioned from work and the ongoing skin issues could potentially exacerbate underlying autoimmune conditions, leading to changes in liver function tests.
Given that you have undergone imaging studies that did not reveal any structural liver issues and have tested negative for viral hepatitis (B and C), it would be prudent to follow up with a healthcare provider who specializes in liver diseases or autoimmune conditions. They may recommend further testing, such as autoimmune panels or a liver biopsy, to assess for autoimmune hepatitis or other liver conditions.
In summary, while the BNT COVID-19 vaccine may cause mild and transient elevations in liver enzymes in some individuals, it is unlikely to be the sole cause of your elevated ALT levels, especially considering your autoimmune history. It is essential to work closely with your healthcare provider to determine the underlying cause of your elevated liver enzymes and to develop an appropriate management plan. Monitoring your liver function over time and addressing any underlying autoimmune issues will be crucial in managing your health effectively.
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