A case of myopericarditis with pleuritis following AstraZeneca Covid-19 vaccination

Hung, Yu-Po; Sun, Kuo-Shao

doi:10.1093/qjmed/hcab278

Cited by 17 publications

(14 citation statements)

References 6 publications

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“…Overall, 266 publications were retrieved for review of full‐text articles. Finally, 102 publications, including 56 case reports 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 92 , 93 , 94 , 97 , 98 , 101 , 102 , 105 , 106 an...…”

Section: Resultsmentioning

confidence: 99%

“… 5 An increasing number of studies have utilized cardiac MRI, as the most important noninvasive diagnostic tool, to assess suspected myocarditis associated with COVID‐19 vaccination. 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , …”

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confidence: 99%

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Cardiac MRI Findings in COVID‐19 Vaccine‐Related Myocarditis: A Pooled Analysis of 468 Patients

Samimisedeh

Afshar

Hassani

et al. 2022

Magnetic Resonance Imaging

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Understanding the pattern and severity of myocarditis caused by the coronavirus disease 2019 (COVID‐19) vaccine is imperative for improving the care of the patients, and cardiac evaluation by MRI plays a key role in this regard. Our systematic review and meta‐analysis aimed to summarize cardiac MRI findings in COVID‐19 vaccine‐related myocarditis. We performed a comprehensive systematic review of literature in PubMed, Scopus, and Google Scholar databases using key terms covering COVID‐19 vaccine, myocarditis, and cardiac MRI. Individual‐level patient data (IPD) and aggregated‐level data (AD) studies were pooled through a two‐stage analysis method. For this purpose, all IPD were first gathered into a single data set and reduced to AD, and then this AD (from IPD studies) was pooled with existing AD (from the AD studies) using fixed/random effect models. I 2 was used to assess the degree of heterogeneity, and the prespecified level of statistical significance ( P value for heterogeneity) was <0.1. Based on meta‐analysis of 102 studies ( n = 468 patients), 79% (95% confidence interval [CI]: 54%–97%) of patients fulfilled Lake Louise criteria (LLC) for diagnosis of myocarditis. Cardiac MRI abnormalities included elevated T2 in 72% (95% CI: 50%–90%), myocardial late gadolinium enhancement (LGE) in 93% (95% CI: 83%–99%; nearly all with a subepicardial and/or midwall pattern), impaired left ventricular ejection fraction (LVEF) (<50%) in 4% (95% CI: 1.0%–9.0%). Moreover, elevated T1 and extracellular volume fraction (ECV) (>30), reported only by some IPD studies, were detected in 74.5% (76/102) and 32% (16/50) of patients, respectively. In conclusion, our findings may suggest that over two‐thirds of patients with clinically suspected myocarditis following COVID‐19 vaccination meet the LLC. COVID‐19 vaccine‐associated myocarditis may show a similar pattern compared to other acute myocarditis entities. Notably, preserved LVEF is probably a common finding in these patients. Evidence Level 4 Technical Efficacy Stage 3

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Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

Cardiac MRI Findings in COVID‐19 Vaccine‐Related Myocarditis: A Pooled Analysis of 468 Patients

Samimisedeh

Afshar

Hassani

et al. 2022

Magnetic Resonance Imaging

View full text Add to dashboard Cite

show abstract

“…While myocarditis has been extensively reported following mRNA COVID-19 vaccines, very few reports exist regarding the development of myocarditis in relation to the ChAdOx1 vaccine ( 136 ). In the latter, the patient was given a diagnosis of myopericarditis with pleuritis.…”

Section: Autoimmune Adverse Events Following Immunization and Their C...mentioning

confidence: 99%

COVID-19 Vaccination and the Rate of Immune and Autoimmune Adverse Events Following Immunization: Insights From a Narrative Literature Review

et al. 2022

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Despite their proven efficacy and huge contribution to the health of humankind, vaccines continue to be a source of concern for some individuals around the world. Vaccinations against COVID-19 increased the number of distressed people and intensified their distrust, particularly as the pandemic was still emerging and the populations were encouraged to be vaccinated under various slogans like “back to normal life” and “stop coronavirus”, goals which are still to be achieved. As fear of vaccination-related adverse events following immunization (AEFIs) is the main reason for vaccine hesitancy, we reviewed immune and autoimmune AEFIs in particular, though very rare, as the most worrisome aspect of the vaccines. Among others, autoimmune AEFIs of the most commonly administered COVID-19 vaccines include neurological ones such as Guillain-Barre syndrome, transverse myelitis, and Bell’s palsy, as well as myocarditis. In addition, the newly introduced notion related to COVID-19 vaccines, “vaccine-induced immune thrombotic thrombocytopenia/vaccine-induced prothrombotic immune thrombotic thrombocytopenia” (VITT/VIPITT)”, is of importance as well. Overviewing recent medical literature while focusing on the major immune and autoimmune AEFIs, demonstrating their rate of occurrence, presenting the cases reported, and their link to the specific type of COVID-19 vaccines represented the main aim of our work. In this narrative review, we illustrate the different vaccine types in current use, their associated immune and autoimmune AEFIs, with a focus on the 3 main COVID-19 vaccines (BNT162b2, mRNA-1273, and ChAdOx1). While the rate of AEFIs is extremely low, addressing the issue in this manner, in our opinion, is the best strategy for coping with vaccine hesitancy.

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“…They are not widely recognized as possible adverse reactions of AstraZeneca COVID-19 vaccine, though the incidence of suspected myocarditis–pericarditis following mRNA and AstraZeneca COVID-19 vaccine from the vaccine adverse event reporting system was similar (1.6–5.0 versus 2.0–3.7 per million doses, respectively) [ 6 ]. To date, only a few cases of myocarditis following exposure to the AstraZeneca COVID-19 vaccine have been published [ 7 , 8 ]. Our patient age was not common for mRNA-induced myocarditis, but the typical age of AstraZeneca COVID-19 vaccine-related myocarditis has not previously been concluded.…”

Section: Discussionmentioning

confidence: 99%

“…Our patient age was not common for mRNA-induced myocarditis, but the typical age of AstraZeneca COVID-19 vaccine-related myocarditis has not previously been concluded. Vaccine-related myocarditis usually presented with mild symptoms, which resolved spontaneously with conservative treatment [ 7 , 9 ]. A severe form presented with cardiogenic shock and need for hemodynamic support had been scarcely reported [ 8 , 10 ].…”

Section: Discussionmentioning

confidence: 99%

Concomitant myocarditis and painless thyroiditis after AstraZeneca coronavirus disease 2019 vaccination: a case report

et al. 2022

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Background Incidence of myocarditis following messenger RNA coronavirus disease 2019 vaccination has been widely described, but this clinical scenario after adenoviral vector coronavirus disease 2019 vaccination has only been rarely reported. In addition, a few case reports of thyroiditis after adenoviral vector coronavirus disease 2019 vaccination have been published. Case presentation A 55-year-old Thai woman presented with palpitation without neck pain 14 days after receiving AstraZeneca coronavirus disease 2019 vaccination. Electrocardiography revealed sinus tachycardia. Her blood tests showed elevation of cardiac troponin and free triiodothyronine with suppressed serum thyroid stimulating hormone, reflecting a hyperthyroid status. Evidence of myocardial inflammation and necrosis from cardiac magnetic resonance imaging supported the diagnosis of recent myocarditis. Laboratory results and imaging findings were consistent with thyroiditis. After 3 weeks of symptomatic treatment, her symptom and blood tests had returned to normal. Conclusions This case demonstrates that the adenoviral vector coronavirus disease 2019 vaccine could possibly cause myocarditis and painless thyroiditis. Clinicians should have a high index of suspicion and promptly evaluate these conditions, despite minimal symptoms.

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A case of myopericarditis with pleuritis following AstraZeneca Covid-19 vaccination

Cited by 17 publications

References 6 publications

Cardiac MRI Findings in COVID‐19 Vaccine‐Related Myocarditis: A Pooled Analysis of 468 Patients

Cardiac MRI Findings in COVID‐19 Vaccine‐Related Myocarditis: A Pooled Analysis of 468 Patients

COVID-19 Vaccination and the Rate of Immune and Autoimmune Adverse Events Following Immunization: Insights From a Narrative Literature Review

Concomitant myocarditis and painless thyroiditis after AstraZeneca coronavirus disease 2019 vaccination: a case report

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