Acute Myocarditis after COVID-19 vaccination: A case report

Abstract

Introduction : The etiology of myocarditis often remains undetermined. A large variety of infectious agents, systemic diseases, drugs, and toxins can cause the disease. We report the case of a 19-year-old man who developed myocarditis three days after Pfizer-BioNTech COVID-19 booster vaccination. Case report : A 19-year-old man, presenting with troponin-positive acute chest pain, was referred to our department. He had received the Pfizer-BioNTech COVID-19 vaccine three days prior to his admission. The diagnosis of acute myocarditis was confirmed by cardiovascular magnetic resonance imaging. Patient hemodynamic status remained stable during hospitalization. The left ventricular ejection fraction was preserved during hospital stay and at one-month follow-up. We found no evidence for another infectious or autoimmune etiology. Conclusion : Although imputability of the vaccine cannot be formally established, the findings raise the possibility of an association between mRNA COVID-19 vaccination and acute myocarditis.

Case Report: Transient Increase of CMR T1 Mapping Indices in a Patient With COVID-19 mRNA Vaccine Induced Acute Myocarditis

“…The Vaccine Adverse Event Reporting System (VAERS) has already received 1226 preliminary reports of myocarditis and pericarditis after about 300 million doses of the Pfizer and Moderna vaccines (until mid-2021) ( 15 ). A recent study highlighting the adverse events associated with the use of mRNA COVID-19 vaccines (BNT162b2 mRNA) outlined the risk of acute kidney injury, arrhythmias, deep vein thrombosis, pulmonary embolism and Bell's palsy in addition to myocarditis.…”

Epidemiology, clinical ramifications, and cellular pathogenesis of COVID-19 mRNA-vaccination-induced adverse cardiovascular outcomes: A state-of-the-heart review

“…While the ACE2 receptor has been implicated in the pathogenesis of COVID-19-induced myocardial injury leading to Takotsubo syndrome, the mechanism underlying the vaccine-induced entity of Takotsubo syndrome is not expected to herald comparable levels of cardiac injury [19] . Rather than direct damage to the heart as in infection, it was postulated that the vaccine may stimulate a systemic inflammatory response that merely sensitizes patients to catecholaminergic effects, resulting in an imbalance between sympathetic and parasympathetic drives that manifests as Takotsubo cardiomyopathy [19] , [21] , [33] , [34] . Furthermore, it has been postulated that the overwhelming emotional turmoil and stress fomented by the uptake of COVID-19 vaccination can herald even greater catecholamine release, which can precipitate the myocardial stunning that is observed in Takotsubo cardiomyopathy.…”

A Rare Case of Myocarditis After the First Dose of Moderna Vaccine in a Patient With Two Previous COVID-19 Infections

“…Myocarditis is defined as the inflammation of the myocardium, occurring as a result of some pathologic immune changes in the heart [ 1 - 3 ]. These changes include alterations in the number and subtypes of lymphocytes, macrophages, and antibodies [ 3 ].…”

“…The prevalence of myocarditis has been estimated to range from 10.2 to 105.6 per 100,000 people worldwide, and it is predominantly found among young adults of the male sex [ 2 , 4 ]. Myocarditis can be caused by both infectious and non-infectious agents [ 1 , 3 , 5 ], presenting with either focal or diffuse cardiac muscle involvement [ 3 ]. It has also been reported to occur as a rare complication of various coronavirus disease 2019 (COVID-19) vaccines [ 1 , 2 , 5 , 6 ], and among those who received the Moderna vaccine, it has been observed mostly after the second dose [ 6 ].…”

“…Myocarditis can be caused by both infectious and non-infectious agents [ 1 , 3 , 5 ], presenting with either focal or diffuse cardiac muscle involvement [ 3 ]. It has also been reported to occur as a rare complication of various coronavirus disease 2019 (COVID-19) vaccines [ 1 , 2 , 5 , 6 ], and among those who received the Moderna vaccine, it has been observed mostly after the second dose [ 6 ]. Also, to date, there have been a few reports of myocarditis after the first dose of the Moderna vaccine, with or without previous COVID-19 infections.…”