Acute myocarditis following Comirnaty vaccination in a healthy man with previous SARS-CoV-2 infection

Abstract

Myopericarditis following mRNA Covid-19 vaccination has recently been reported to health authorities in a lot of countries. They can occur in very rare cases after either the Moderna (mRNA-1273 - Spikevax) or Pfizer-BioNTech (BNT162b2 - Comirnaty) vaccination. Cases predominately occur in younger adult men within 14 days following the second dose. In this article, we present a 56-year-old man with no prior medical history, whit the exception of a mild Covid-19 infection 4 months earlier, who experienced an episode of acute epigastric pain, profuse sweating, tachycardia, hypotension 4 days after the first dose of BNT162b2 vaccine. Troponin I level was elevated. Chest X-ray, electrocardiogram, echocardiogram, coronary angiography didn't show significant abnormalities. Cardiac Magnetic Resonance showed a pattern of acute myocarditis. The condition appeared to be self-limited and the patient recovered without specific therapy. No report of acute myocarditis was observed in the BNT162b2 and mRNA-1273 trials and very rare cases, in comparison to given doses, have been reported to pharmacovigilance systems worldwide. Further surveillance and evaluation of this side effect are warranted to establish the correct balance of benefits and risks of Covid-19 mRNA vaccines, above all in children and younger people (categories with the higher reactogenicity and the lower risk of Covid-19 complications). At the present time the benefits of Covid-19 vaccination significantly exceed possible risks.

COVID-19 phase 4 vaccine candidates, effectiveness on SARS-CoV-2 variants, neutralizing antibody, rare side effects, traditional and nano-based vaccine platforms: a review

“…In melanoma studies, microneedle applied transcutaneously showed a higher fold of IgG antibody and excess CD8 + T cell response to inhibit the melanoma. A preclinical study on H1N1 examined that DNA vaccine incorporated in liposomes can be delivered orally, resulting in higher IgG titer and activity of T cell response (Park et al 2021 ). A new concept arises in COVID-19 development through inhalation of DNA vaccine directly by using nebulizer or metered-dose inhaler.…”

“…Both the vaccines are composed of lipid nanoparticles that show an efficacy of ~ 95% (Khurana et al 2021 ). Lipid nanoparticles have various advantages that make them suitable as a vehicle to deliver mRNAs, such as the biocompatibility to human use, stability during the passage, efficient encapsulation of the informant, and increased cellular uptake in vivo (Khurana et al 2021 ; Park et al 2021 ). The 5′ and 3′ untranslated regions of mRNA sequences can be engineered systematically to the nanoparticle to ensure efficient delivery (Zeng et al 2020 ).…”

“…The cases are mild and temporarily exist but can cause severe effects on adolescents. Pleuritic chest pain, dyspnoea, or palpitations are the symptoms that can be noticed especially in younger children with myocarditis besides, epigastric pain, profuse sweating, tachycardia, hypotension can also be observed in some cases (Albert et al 2021;Hasnie et al 2021;Maron et al 2021;McLean and Johnson 2021;Patrignani et al 2021;Snapiri et al 2021;Vogel 2021). According to multiple case reports, most of the symptoms for myocarditis arise within 1-4 days after the first or second dose vaccination of BNT162b2 or mRNA-1273.…”

“…According to multiple case reports, most of the symptoms for myocarditis arise within 1-4 days after the first or second dose vaccination of BNT162b2 or mRNA-1273. Younger males, 12-29 years, are predominantly affected; however, a 56-year-old case was also reported with previously SARS-CoV-2 infection but was healthy at the time of vaccination (Maron et al 2021;McLean and Johnson 2021;Patrignani et al 2021;Snapiri et al 2021). Cardiac magnetic resonance imaging was an effective tool for the diagnosis of myocarditis.…”

“…Cardiac magnetic resonance imaging was an effective tool for the diagnosis of myocarditis. Elevated troponin level was reported in almost every case; in some cases, creative protein and creatine kinase, CK-MB, and B-type natriuretic peptide levels were also reported higher (Albert et al 2021;Hasnie et al 2021;Maron et al 2021;McLean and Johnson 2021;Patrignani et al 2021;Snapiri et al 2021). Different drugs were introduced to treat and elevate the symptoms of myocarditis.…”