Immune monitoring of a child with autoimmune hepatitis and type 1 diabetes during COVID-19 infection

Eur J Gastroenterol Hepatol. 2020 Sep;32(9):1251-1255. doi: 10.1097/MEG.0000000000001804.

Abstract

Immunocompromised patients may be at increased risk to develop COVID-19 during the 2019 β-coronavirus infection. We present the unique opportunity we had to monitor the liver, IL-6 and immune cell course before, during and after COVID-19 in a boy with autoimmune hepatitis (AIH) and type 1 diabetes (T1D). CD4 and CD8 T cells frequencies decreased because of prednisolone, followed by a plateauing increase whereas CD19CD20 B cell increased strongly and was unaffected by COVID-19 infection. Moreover, the percentage of activated CD8 T cells expressing HLA-DR (CD8HLA-DR) increased during COVID-19 and subsided after its clearance. Total regulatory T cells (Tregs: CD4CD25CD127FOXP3) remained stable. Although activated Tregs (CD4CD45RAFOXP3) strongly increased upon prednisolone, it decreased afterwards. Furthermore, regulatory B cells (Bregs: CD19CD20CD24CD38) declined sharply owing to prednisolone. Serum IL-6 remained undetectable at all times. We demonstrated for the first time immune monitoring in a child with AIH and T1D before, during and after COVID-19. We hypothesize that continuing with low level of prednisolone without azathioprine may have abrogated activated Tregs, Bregs and IL-6 production and therefore permitting the activation of CD8 T cells, clearing the virus.

Publication types

  • Case Reports

MeSH terms

  • Betacoronavirus*
  • CD4-Positive T-Lymphocytes
  • CD8-Positive T-Lymphocytes
  • COVID-19
  • Child, Preschool
  • Coronavirus Infections / complications
  • Coronavirus Infections / immunology*
  • Coronavirus Infections / therapy*
  • Diabetes Mellitus, Type 1 / complications
  • Diabetes Mellitus, Type 1 / immunology*
  • Diabetes Mellitus, Type 1 / therapy
  • Hepatitis, Autoimmune / complications
  • Hepatitis, Autoimmune / immunology*
  • Hepatitis, Autoimmune / therapy
  • Humans
  • Lymphocyte Count
  • Male
  • Monitoring, Immunologic
  • Pandemics
  • Pneumonia, Viral / complications
  • Pneumonia, Viral / immunology*
  • Pneumonia, Viral / therapy*
  • SARS-CoV-2