Coronavirus Disease 2019 (COVID‐19) in autoimmune hepatitis: a lesson from immunosuppressed patients

Background & Aims Chronic immunosuppression is associated with increased and more severe viral infections. However, little is known about the association between immunosuppression and severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection. Our aim was to describe the clinical course of immunosuppressed autoimmune hepatitis (AIH) patients during coronavirus disease 2019 (COVID‐19) infection in Italy. Methods Our study is a case series of AIH patients treated with immunosuppression, who tested positive for SARS‐CoV‐2 in March 2020 during outbreak of COVID‐19. Results Ten patients from six different hospitals in Italy were diagnosed with COVID‐19 during the outbreak of SARS‐CoV‐2 in March 2020. Seven subjects were female (70%) and age ranged from 27 to 73 years. Before the onset of SARS‐CoV‐2 infection, all patients were taking immunosuppressive therapy for AIH, and eight of them were on biochemical remission. Two other patients had recent acute onset of their AIH, and were consequently started high‐dose steroids, as per induction protocol. All patients had a respiratory syndrome and had a positive nasal swab for SARS‐CoV‐2. Five patients developed a CT‐confirmed COVID‐19 pneumonia. Six subjects received a combination of antiretroviral and antimalarial drugs. In seven patients the dosage of immunosuppressive medication was changed. Liver enzymes were repeated during SARS‐CoV‐2 infection in all hospitalized cases; they remained within the normal range in all cases, and improved in the two acute cases treated with high‐dose steroids. The clinical outcome was comparable to the reported cases occurring in non‐immunosuppressed subjects. Conclusion Patients under immunosuppressive therapy for AIH developing COVID‐19 show a disease course presumptively similar to that reported in non‐immunosuppressed population. These data might help medical decision when dealing with SARS‐CoV‐2 infection in immunocompromised patients.