Fulminant myocarditis following coronavirus disease 2019 vaccination: a case report

Abstract

Background The BNT162b2 vaccine received emergency use authorization from the U.S. Food and Drug Administration for the prevention of severe COVID-19 infection. We report a case of biopsy and MRI-proven severe myocarditis that developed in a previously healthy individual within days of receiving the first dose of the BNT162b2 COVID-19 vaccine. Case Summary An 80-year-old female with no significant cardiac history presented with cardiogenic shock and biopsy-proven fulminant myocarditis within 12 days of receiving the BNT162b2 COVID-19 vaccine. She required temporary mechanical circulatory support, inotropic agents and high-dose steroids for stabilization and management. Ultimately her cardiac function recovered, and she was discharged in stable condition after 2 weeks of hospitalization. A repeat cardiac MRI 3 months after her initial presentation demonstrated stable biventricular function and continued improvement in myocardial inflammation. Discussion Fulminant myocarditis is a rare complication of vaccination. Clinicians should stay vigilant to recognize this rare, but potentially deadly complication. Due to the high morbidity and mortality associated with COVID-19 infection, the clinical benefits of the BNT162b2 vaccine greatly outweighs the risks of complications.

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

“…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...…”

“…A total of 468 patients with suspected myocarditis and cardiac MRI findings were included in this study ( n = 294 from case reports/case series with IPD 5 , 7 , 9 , 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 , 58 , 59 , 60 , 61 , …”

“…A total of 468 patients with suspected myocarditis and cardiac MRI findings were included in this study ( n = 294 from case reports/case series with IPD 5,7,9,11–66,68,70–73,75–87,89,91–95,97–107 and n = 174 from five case series 67,69,74,88,90 with AD). Based on data provided by 100 out of 102 studies, all included patients met CDC criteria for suspected myocarditis.…”

“… 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 , …”

Acute Myopericarditis After the Third Vaccination of BNT162b2 in a Middle-Aged Man

“…Since most cases of myocarditis following the mRNA vaccine have a mild clinical course, there were several reports that non-steroidal anti-inflammatory drugs, intravenous immunoglobulin, glucocorticoids, or colchicine were effective [ 6 ]. Rarely, they become fulminant and require immunosuppressants [ 7 ]. In our case, it is thought that relatively rapid improvement was achieved because lymphocyte infiltration was slight.…”