Reply.

We are pleased to respond to Drs. Mungmunpuntipantip and Wiwanitkit's observations on our recent paper.[ , ]

We completely agree that it is usually difficult to associate autoimmune hepatitis (AIH)‐like syndrome with a drug or vaccine administration. However, more and more cases of post–anti‐severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) vaccination are being recorded.[ , , ] Among them, Tun et al. reported a patient with liver injury after the first vaccine, with improvement until the second dose was administered; after that, the patient had a worsening of liver biochemistry.[ ]

In our case, the patient underwent excessive laboratory testing, excluding other causes of transaminasemia, including viral hepatitis, Epstein‐Barr virus, and cytomegalovirus. Moreover, the patient was followed up for 5 months before liver biopsy (LB) was decided so that other viral causes could be safely excluded. Our patient’s LB was consistent with AIH‐like syndrome, and she improved with corticosteroid treatment.

Overall, we think that even though pinpointing the cause of AIH‐like syndrome is a difficult task, we now have cumulating evidence in the literature proving that this syndrome is a rare, but existent, side effect of mRNA‐based anti‐SARS‐CoV‐2 vaccines.

CONFLICT OF INTEREST

Nothing to report.