Giant cell myocarditis after first dose of BNT162b2 – a case report

Abstract

Herein we report the case of a young man, admitted to the Department of Cardiology and Angiology at Hannover Medical School with shortness of breath and elevated troponin. Few weeks earlier the patient received the first dose of BioNTech's mRNA vaccine (Comirnaty, BNT162b2). After diagnostic work-up revealed giant cell myocarditis, the patient received immunosuppressive therapy. In the present context of myocarditis after mRNA vaccination we discuss this rare aetiology and the patient's treatment strategy in the light of current recommendations.

February 2023 at a glance: focus on pathophysiology and treatment

“…The administration of COVID‐19 vaccination is recommended in HF patients 42 . Although generally safe, post‐vaccine myocarditis was observed 43,44 . In a prospective study including 324 health workers receiving the fourth dose of the Pfizer‐BioNTech vaccine, pain at injection site and fatigue were the most common adverse events.…”

“…42 Although generally safe, post-vaccine myocarditis was observed. 43,44 In a prospective study including 324 health workers receiving the fourth dose of the Pfizer-BioNTech vaccine, pain at injection site and fatigue were the most common adverse events. Vaccine-related myocardial injury, as assessed with high-sensitivity cardiac troponin during vaccine administration and 2-4 days afterward, was only found in 2 patients (0.62%), of whom one presented mild symptoms and the other was asymptomatic.…”

Commentary on: “Autopsy-based histopathological characterization of myocarditis after anti-SARS-CoV-2-vaccination” by C. Schwab et al.

“…The overall histological phenotype of severe or fatal cases appears to be multifocal cardiomyocyte damage associated with a mixed inflammatory cell infiltrate including eosinophils [14][15][16][17][18]. Some papers suggest that giant cell myocarditis may occur following COVID-19 vaccination [19][20][21]. The demographics of the reported patients is also outside the highest risk of vaccine-associated myocarditis, being adolescent men and young adult males aged 16-24 years, with the highest rates noted following the second dose of a COVID-19 vaccine [22].…”

The MSH3 Gene From A Neuropsychiatrist’s Perspective

“…As COVID-19 mRNA vaccines elicit the expression of full-length S antigen (including the FCS), these therapeutics may promote pathological syncytia [20]. Along this line, giant cell myocarditis and arteritis due to pathological cell-cell fusion were recorded in Vaccine Adverse Event Reporting System (VAERS) [21,22].Pfizer and Moderna COVID-19 messenger RNA (mRNA) vaccines are heavily engineered to facilitate translation and improve stability, modifications that include codon optimization enriched with CG repeats [6]. However, as MSH3 regulates STRs, including the CG repetitions, vaccine efficacy is likely enhanced by the inhibition or attenuation of this protein.…”

“…As COVID-19 mRNA vaccines elicit the expression of full-length S antigen (including the FCS), these therapeutics may promote pathological syncytia [20]. Along this line, giant cell myocarditis and arteritis due to pathological cell-cell fusion were recorded in Vaccine Adverse Event Reporting System (VAERS) [21,22].…”