Hepatitis B Virus Reactivation After COVID-19 Vaccination A Case Report

Reactivation of different viruses after COVID-19 vaccination has been identified, such as hepatitis C virus, herpes viruses, and Epstein Barr virus. In this case, a middle-aged female patient treated for hepatitis B virus (HBV) by tenofovir and developed persistent hepatitis B envelope antigen seroconversion with lack of viremia. She received the first dose of an inactivated COVID-19 vaccine. Three days later, manifestations of acute hepatitis occurred. The liver enzymes were elevated; alanine aminotransferase was 286 U/L, aspartate aminotransferase 160 U/L, HBV DNA level 208,000 IU/L and HBs Ag level 2944 IU/L. Retreatment by tenofovir was initiated and symptoms improved with reduction of liver enzymes. Three months later, liver enzymes became at normal level. This is considered the first report of HBV reactivation after COVID-19 vaccine. Patients with HBV infection who stopped HBV treatment after hepatitis B envelope antigen seroconversion should be closely monitored after COVID-19 vaccination for the possibility of HBV reactivation to determine if it is a true causality or just an association.