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Myocarditis is now recognized as a rare complication of coronavirus disease 2019 (COVID-19) mRNA vaccination, particularly in adolescent and young adult males. Since the authorization of the Pfizer-BioNTech™ and Moderna™ mRNA vaccines targeting the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) spike protein, the Centers for Disease Control and Prevention (CDC) has reported 1175 confirmed cases of myocarditis after COVID-19 vaccination in individuals ages 30 years and younger as of January 2022. According to CDC data in June 2021, the incidence of vaccine-mediated myocarditis in males ages 12-29 years old was estimated to be 40.6 cases per million second doses of COVID-19 mRNA vaccination administered. Individuals with cases of COVID-19 vaccine-mediated myocarditis typically present with acute chest pain and elevated serum troponin levels, often within one week of receiving the second dose of mRNA COVID-19 vaccination. Most cases follow a benign clinical course with prompt resolution of symptoms. Proposed mechanisms of COVID-19 vaccine myocarditis include molecular mimicry between SARS-CoV-2 spike protein and self-antigens and the triggering of preexisting dysregulated immune pathways in predisposed individuals. The higher incidence of COVID-19 vaccine myocarditis in young males may be explained by testosterone and its role in modulating the immune response in myocarditis. There is limited data on long-term outcomes in these cases given the recency of their occurrence. The CDC continues to recommend COVID-19 vaccination for everyone 5 years of age and older given the greater risk of serious complications related to natural COVID-19 infection including hospitalization, multisystem organ dysfunction, and death. Further study is needed to better understand the immunopathology and long-term outcomes behind COVID-19 mRNA vaccine-mediated myocarditis.
Introduction:The incidence of esophageal perforation following anterior cervical spine surgery is reported to be between 0.02% and 1.49% with mortality rate around 6 percent. Although most esophageal erosions occur in intraoperative or immediately following surgical intervention, few cases reported with delayed presentation. Diagnosis can be made with cervical radiographs, however negative imaging does not rule out esophageal injury and further evaluation with surgical exploration warranted in the presence of high clinical suspicion. Case Description/Methods: A 58-year-old male patient with past medical history significant for Parkinson's disease, and solitary cervical spinal sarcoma who underwent corpectomy, fusion of C3-C6 with cervical fixation plate placement and stereotactic body radiation therapy, presented with 3 weeks history of dysphagia, concomitant with weakness, diplopia, and weakness. Initial work up, revealed aerodigestive tract soft tissue enhancement in the cervical magnetic resonance imaging (MRI). Dysphagia progressed during the course of hospitalization and complicated with aspiration pneumonia and respiratory failure requiring intubation and mechanical ventilation. Patient subsequently underwent endoscopic gastroesophageal duodenoscopy (EGD) for further evaluation and PEG placement, which revealed posterior pharyngeal wall, and upper cervical esophageal erosion and presence of cervical fixation plate in the hypopharynx. Patient underwent surgical exploration of cervical spine, and the anterior cervical fixation plate removed with flap reconstruction and cervical dural tear repaired with resolution of his symptoms. Discussion: Our patient presented with progressive dysphagia as delayed manifestation of posterior pharyngeal wall erosion. EGD revealed the diagnosis and patient underwent surgical exploration of cervical spine, and the anterior cervical fixation plate removed with flap reconstruction and cervical dural tear repaired with resolution of his symptoms. There are few cases reported in the literature with esophageal perforation following anterior cervical spine surgery. Although most esophageal erosions occur in intraoperative or immediately following surgical intervention, few cases reported with delayed presentation.
Myocarditis is now recognized as a rare complication of coronavirus disease 2019 (COVID-19) mRNA vaccination, particularly in adolescent and young adult males. Since the authorization of the Pfizer-BioNTech™ and Moderna™ mRNA vaccines targeting the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) spike protein, the Centers for Disease Control and Prevention (CDC) has reported 1175 confirmed cases of myocarditis after COVID-19 vaccination in individuals ages 30 years and younger as of January 2022. According to CDC data in June 2021, the incidence of vaccine-mediated myocarditis in males ages 12-29 years old was estimated to be 40.6 cases per million second doses of COVID-19 mRNA vaccination administered. Individuals with cases of COVID-19 vaccine-mediated myocarditis typically present with acute chest pain and elevated serum troponin levels, often within one week of receiving the second dose of mRNA COVID-19 vaccination. Most cases follow a benign clinical course with prompt resolution of symptoms. Proposed mechanisms of COVID-19 vaccine myocarditis include molecular mimicry between SARS-CoV-2 spike protein and self-antigens and the triggering of preexisting dysregulated immune pathways in predisposed individuals. The higher incidence of COVID-19 vaccine myocarditis in young males may be explained by testosterone and its role in modulating the immune response in myocarditis. There is limited data on long-term outcomes in these cases given the recency of their occurrence. The CDC continues to recommend COVID-19 vaccination for everyone 5 years of age and older given the greater risk of serious complications related to natural COVID-19 infection including hospitalization, multisystem organ dysfunction, and death. Further study is needed to better understand the immunopathology and long-term outcomes behind COVID-19 mRNA vaccine-mediated myocarditis. <br><b>Original article:</b> Morgan MC, Atri L, Harrell S, Al-Jaroudi W, Berman A. COVID-19 vaccine-associated myocarditis. World J Cardiol. 2022;14(7):382-391. DOI: 10.4330/wjc.v14.i7.382. <br><i>The article was translated into Russian and published under the terms of the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license.</i>
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