Liver injury secondary to vaccination is a rare adverse event that has recently come under attention thanks to the continuous pharmacovigilance following the widespread implementation of coronavirus disease 2019(COVID...Liver injury secondary to vaccination is a rare adverse event that has recently come under attention thanks to the continuous pharmacovigilance following the widespread implementation of coronavirus disease 2019(COVID-19)vaccination protocols.All three most widely distributed severe acute respiratory syndrome coronavirus 2 vaccine formulations,e.g.,BNT162b2,mRNA-1273,and ChAdOx1-S,can induce liver injury that may involve immune-mediated pathways and result in autoimmune hepatitis-like presentation that may require therapeutic intervention in the form of corticosteroid administration.Various mechanisms have been proposed in an attempt to highlight immune checkpoint inhibition and thus establish causality with vaccination.The autoimmune features of such a reaction also prompt an in-depth investigation of the newly employed vaccine technologies.Novel vaccine delivery platforms,e.g.,mRNA-containing lipid nanoparticles and adenoviral vectors,contribute to the inflammatory background that leads to an exaggerated immune response,while patterns of molecular mimicry between the spike(S)protein and prominent liver antigens may account for the autoimmune presentation.Immune mediators triggered by vaccination or vaccine ingredients per se,including autoreactive antibodies,cytokines,and cytotoxic T-cell populations,may inflict hepatocellular damage through wellestablished pathways.We aim to review available data associated with immunemediated liver injury associated with COVID-19 vaccination and elucidate potential mechanisms underlying its pathogenesis.展开更多
Acute pancreatitis(AP) is one of the most common diseases of the gastrointestinal tract,bearing significant morbidity and mortality worldwide.Current treatment of AP remains unspecific and supportive and is mainly tar...Acute pancreatitis(AP) is one of the most common diseases of the gastrointestinal tract,bearing significant morbidity and mortality worldwide.Current treatment of AP remains unspecific and supportive and is mainly targeted to aggressively prevent systemic complications and organ failure by intensive care.As acute pancreatitis shares an indistinguishable profile of inflammation with sepsis,therapeutic approaches have turned towards modulating the systemic inflammatory response.Targets,among others,have included pro- and antiinflammatory modulators,cytokines,chemokines,immune cells,adhesive molecules and platelets.Even though,initial results in experimental models have been encouraging,clinical implementation of immuneregulating therapies in acute pancreatitis has had a slow progress.Main reasons include difficulty in clinical translation of experimental data,poor understanding of inflammatory response time-course,flaws in experimental designs,need for multimodal approaches and commercial drawbacks.Whether immune-modulation in acute pancreatitis remains a fact or just fiction remains to be seen in the future.展开更多
Major complications of endoscopic retrograde cholangiopancreatography (ERCP) include pancreatitis, hemorrhage, cholangitis, and duodenal perforation. The occurrence of free air in the peritoneal cavity post- ERCP is a...Major complications of endoscopic retrograde cholangiopancreatography (ERCP) include pancreatitis, hemorrhage, cholangitis, and duodenal perforation. The occurrence of free air in the peritoneal cavity post- ERCP is a rare event (< 1%), which is usually the result of duodenal or ductal perforation related to therapeutic ERCP with sphincterotomy. We describe for the first time a different aetiology of pneumoperitoneum, in an 84-year-old woman with pancreatic cancer and a large hepatic metastasis, after ERCP with common bile duct stent deployment. Our patient developed, pneumoperitoneum due to air leakage from rupture of intrahepatic bile ducts and Glisson’s capsule in the area of a peripheral large hepatic metastasis. The potential mechanism underlying this complication might be post- ERCP pneumobilia and increased pressure of intrahepatic bile ducts leading to rupture of intrahepatic bile ducts in the liver metastatic mass owing to neoplastic tissue friability. This case indicates the need for close clinical and radiological observation of patients with hepatic masses (primary or metastatic) subjected to ERCP. In such patients, avoidance of excessive air insufflation during ERCP and/or placement of a nasogastric tube for bowel decompression immediately after ERCP might be a reasonable strategy to prevent such unusual complications.展开更多
文摘Liver injury secondary to vaccination is a rare adverse event that has recently come under attention thanks to the continuous pharmacovigilance following the widespread implementation of coronavirus disease 2019(COVID-19)vaccination protocols.All three most widely distributed severe acute respiratory syndrome coronavirus 2 vaccine formulations,e.g.,BNT162b2,mRNA-1273,and ChAdOx1-S,can induce liver injury that may involve immune-mediated pathways and result in autoimmune hepatitis-like presentation that may require therapeutic intervention in the form of corticosteroid administration.Various mechanisms have been proposed in an attempt to highlight immune checkpoint inhibition and thus establish causality with vaccination.The autoimmune features of such a reaction also prompt an in-depth investigation of the newly employed vaccine technologies.Novel vaccine delivery platforms,e.g.,mRNA-containing lipid nanoparticles and adenoviral vectors,contribute to the inflammatory background that leads to an exaggerated immune response,while patterns of molecular mimicry between the spike(S)protein and prominent liver antigens may account for the autoimmune presentation.Immune mediators triggered by vaccination or vaccine ingredients per se,including autoreactive antibodies,cytokines,and cytotoxic T-cell populations,may inflict hepatocellular damage through wellestablished pathways.We aim to review available data associated with immunemediated liver injury associated with COVID-19 vaccination and elucidate potential mechanisms underlying its pathogenesis.
文摘Acute pancreatitis(AP) is one of the most common diseases of the gastrointestinal tract,bearing significant morbidity and mortality worldwide.Current treatment of AP remains unspecific and supportive and is mainly targeted to aggressively prevent systemic complications and organ failure by intensive care.As acute pancreatitis shares an indistinguishable profile of inflammation with sepsis,therapeutic approaches have turned towards modulating the systemic inflammatory response.Targets,among others,have included pro- and antiinflammatory modulators,cytokines,chemokines,immune cells,adhesive molecules and platelets.Even though,initial results in experimental models have been encouraging,clinical implementation of immuneregulating therapies in acute pancreatitis has had a slow progress.Main reasons include difficulty in clinical translation of experimental data,poor understanding of inflammatory response time-course,flaws in experimental designs,need for multimodal approaches and commercial drawbacks.Whether immune-modulation in acute pancreatitis remains a fact or just fiction remains to be seen in the future.
文摘Major complications of endoscopic retrograde cholangiopancreatography (ERCP) include pancreatitis, hemorrhage, cholangitis, and duodenal perforation. The occurrence of free air in the peritoneal cavity post- ERCP is a rare event (< 1%), which is usually the result of duodenal or ductal perforation related to therapeutic ERCP with sphincterotomy. We describe for the first time a different aetiology of pneumoperitoneum, in an 84-year-old woman with pancreatic cancer and a large hepatic metastasis, after ERCP with common bile duct stent deployment. Our patient developed, pneumoperitoneum due to air leakage from rupture of intrahepatic bile ducts and Glisson’s capsule in the area of a peripheral large hepatic metastasis. The potential mechanism underlying this complication might be post- ERCP pneumobilia and increased pressure of intrahepatic bile ducts leading to rupture of intrahepatic bile ducts in the liver metastatic mass owing to neoplastic tissue friability. This case indicates the need for close clinical and radiological observation of patients with hepatic masses (primary or metastatic) subjected to ERCP. In such patients, avoidance of excessive air insufflation during ERCP and/or placement of a nasogastric tube for bowel decompression immediately after ERCP might be a reasonable strategy to prevent such unusual complications.
