J Korean Med Sci.  2021 Oct;36(39):e277. 10.3346/jkms.2021.36.e277.

A Case Report for Myopericarditis after BNT162b2 COVID-19 mRNA Vaccination in a Korean Young Male

Affiliations
  • 1Division of Cardiology, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
  • 2Division of Cardiology, Department of Internal Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea

Abstract

Mass vaccination with the Pfizer-BioNTech coronavirus disease 2019 (COVID-19) vaccine (BNT162b2) in Korea has resulted in many reported adverse effects. These side effects are the object of much scrutiny in the medical community. We report the case of a 29-year-old male who was diagnosed with myopericarditis after his second dose of Pfizer-BioNTech COVID-19 vaccine. This patient is the second recognized case of Pfizer-BioNTech COVID-19 vaccine induced myopericarditis in Korea and the first to have recovered from it. He originally presented with chest discomfort and exertional chest pain. Lab tests revealed elevated cardiac marker levels and echocardiographic findings displayed minimal pericardial effusion, prompting diagnosis as myopericarditis. We decided on two weeks of outpatient treatment with non-steroidal anti-inflammatory drugs (NSAIDs) due to the patient's mild symptoms and his occupation in the military. When this proved insufficient, we shifted to combination therapy with low dose corticosteroids and NSAIDs. After two weeks of treatment, the patient's symptoms and pericardial effusion had improved, and he was recovered completely 37 days after the onset.

Keyword

COVID-19; Pfizer-BioNTech Vaccine; Adverse Effects; Male; Myopericarditis

Figure

  • Fig. 1 ECG performed on the day of first visit. The ECG shows normal sinus rhythm, normal axis and 75 beats per minute without ST-T changes in any lead.ECG = electrocardiogram.

  • Fig. 2 Chest X-ray performed on the day of first visit and last follow-up. (A) Chest X-ray shows mild cardiomegaly. (B) Chest X-ray shows improving cardiomegaly.

  • Fig. 3 Echocardiogram performed on first day of visit and last follow-up. RV focusing view at diastolic phase (A, B). (A) Image taken on June 30 shows 3.5 mm of minimal pericardial effusion at RV lateral side. (B) Image taken on August 6 shows improvement. Refer to Supplementary Videos 1 and 2 to see imaging in relation to cardiac cycle.Parasternal short axis view (mitral valve level) at diastolic phase (C, D). (C) Image taken on June 30 shows 3 mm of minimal pericardial effusion at the RV free wall. (D) Image taken on August 6 shows improvement.RV = right ventricle.

  • Fig. 4 Cardiac MRI of acute myopericarditis taken on August 6. (A) MRI 4 chamber cine image. (B) MRI 2 chamber left cine image. Scanty pericardial effusion was observed and no abnormalities were found in the myocardium wall. Refer to Supplementary Videos 3 and 4 for details.MRI = magnetic resonance imaging.


Cited by  1 articles

A Case Report for Acute Myopericarditis After NVX-CoV2373 (Novavax®) COVID-19 Vaccination
Hyung Yoon Kim, Jae Yeong Cho, Hyun Ju Yoon, Yoo-Duk Choi, Youngkeun Ahn, Myung Ho Jeong, Jeong Gwan Cho, Kye Hun Kim
J Korean Med Sci. 2022;37(34):e265.    doi: 10.3346/jkms.2022.37.e265.


Reference

1. Spodick DH. The pericardium: a comprehensive textbook. New York, NY, USA: Marcel Dekker, Inc.;1996.
2. Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E. Braunwald's Heart Disease: a Textbook of Cardiovascular Medicine. Philadelphia, PA, USA: Elsevier/Saunders;2019.
3. Cassimatis DC, Atwood JE, Engler RM, Linz PE, Grabenstein JD, Vernalis MN. Smallpox vaccination and myopericarditis: a clinical review. J Am Coll Cardiol. 2004; 43(9):1503–1510. PMID: 15120802.
Article
4. COVID-19 Subcommittee of the WHO Global Advisory Committee on Vaccine Safety (GACVS). Updated guidance regarding myocarditis and pericarditis reported with COVID-19 mRNA vaccines. Updated 2021. Accessed July 28, 2021. https://www.who.int/news/item/09-07-2021-gacvs-guidance-myocarditis-pericarditis-covid-19-mrna-vaccines.
5. Imazio M, Trinchero R. Myopericarditis: Etiology, management, and prognosis. Int J Cardiol. 2008; 127(1):17–26. PMID: 18221804.
Article
6. Maisch B, Seferović PM, Ristić AD, Erbel R, Rienmüller R, Adler Y, et al. Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology. Eur Heart J. 2004; 25(7):587–610. PMID: 15120056.
7. Adler Y, Charron P, Imazio M, Badano L, Barón-Esquivias G, Bogaert J, et al. 2015 ESC Guidelines for the diagnosis and management of pericardial diseases. Eur Heart J. 2015; 36(42):2921–2964. PMID: 26320112.
Article
8. Imazio M, Brucato A, Barbieri A, Ferroni F, Maestroni S, Ligabue G, et al. Good prognosis for pericarditis with and without myocardial involvement: results from a multicenter, prospective cohort study. Circulation. 2013; 128(1):42–49. PMID: 23709669.
9. Imazio M, Cooper LT. Management of myopericarditis. Expert Rev Cardiovasc Ther. 2013; 11(2):193–201. PMID: 23405840.
Article
10. Su JR, McNeil MM, Welsh KJ, Marquez PL, Ng C, Yan M, et al. Myopericarditis after vaccination, vaccine adverse event reporting system (VAERS), 1990–2018. Vaccine. 2021; 39(5):839–845. PMID: 33422381.
Article
11. Halsell JS, Riddle JR, Atwood JE, Gardner P, Shope R, Poland GA, et al. Myopericarditis following smallpox vaccination among vaccinia-naive US military personnel. JAMA. 2003; 289(24):3283–3289. PMID: 12824210.
Article
12. Singh B, Kaur P, Cedeno L, Brahimi T, Patel P, Virk H, et al. COVID-19 mRNA vaccine and myocarditis. Eur J Case Rep Intern Med. 2021; 8(7):002681. PMID: 34268277.
Article
13. Watkins K, Griffin G, Septaric K, Simon EL. Myocarditis after BNT162b2 vaccination in a healthy male. Am J Emerg Med. Forthcoming. 2021; DOI: 10.1016/j.ajem.2021.06.051.
Article
14. Vidula MK, Ambrose M, Glassberg H, Chokshi N, Chen T, Ferrari VA, et al. Myocarditis and other cardiovascular complications of the mRNA-based COVID-19 Vaccines. Cureus. 2021; 13(6):e15576. PMID: 34277198.
Article
15. Mansour J, Short RG, Bhalla S, Woodard PK, Verma A, Robinson X, et al. Acute myocarditis after a second dose of the mRNA COVID-19 vaccine: a report of two cases. Clin Imaging. 2021; 78:247–249. PMID: 34166884.
Article
16. Kim HW, Jenista ER, Wendell DC, Azevedo CF, Campbell MJ, Darty SN, et al. Patients with acute myocarditis following mRNA COVID-19 vaccination. JAMA Cardiol. Forthcoming. 2021; DOI: 10.1001/jamacardio.2021.2828.
Article
17. King WW, Petersen MR, Matar RM, Budweg JB, Cuervo Pardo L, Petersen JW. Myocarditis following mRNA vaccination against SARS-CoV-2, a case series. Am Heart J Plus. 2021; 8:100042. PMID: 34396358.
Article
18. Korea Disease Control and Prevention Agency. KDCA 2021.07.26 Regular Briefing Press Release. Updated 2021. Accessed October 8, 2021. https://www.korea.kr/news/pressReleaseView.do?newsId=156463392#sitemap-layer.
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