J Korean Med Sci.  2022 Apr;37(13):e104. 10.3346/jkms.2022.37.e104.

A Case of Heart Transplantation for Fulminant Myocarditis After ChAdOx1 nCoV-19 Vaccination

• Kim SH
• Lee SY
• Kim GY
• Oh JS
• Kim J
• Chun KJ
• Ju MH
• Lee Ch
• Song YJ
• Na JY

• KMID: 2527830
• DOI: http://doi.org/10.3346/jkms.2022.37.e104

Abstract

Vaccines have become the mainstay of management against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (coronavirus disease 2019; COVID-19) in the absence of effective antiviral therapy. Various adverse effects of COVID-19 vaccination have been reported, including cardiovascular complications such as myocarditis or pericarditis. Herein, we describe clinical records of a 63-year woman with fulminant myocarditis following ChAdOx1 nCoV-19 vaccination that was salvaged by heart transplantation. She complained chest pain, nausea, vomiting, and fever after the second vaccination. After the heart transplantation, the patient died due to necrotizing pneumonia on the 54th day of onset. Fulminant myocarditis is very rare after ChAdOx1 nCoV-19 vaccination but can be fatal.

Keyword

ChAdOx1 nCoV-19 Vaccine; Myocarditis; COVID-19; AstraZeneca

Figure

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  Fig. 1 Chest X-ray. (A) Bilateral pulmonary infiltration where right lung was developing. (B) Post-transplant X-ray turned into total whiteout.

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  Fig. 2 The evidences of thrombi. (A) Spontaneous echogenic material in the tubular portion of ascending aorta. (B) 7 cm-long huge thrombus of aortic root obtained intraoperatively. Thrombus in the form of left anterior descending artery (Long arrow), right coronary artery os (cut) (short arrow). The rest of linear thrombi occluding the right coronary artery is shown in the Fig. 2B. (C) Chest tomography displayed as a thrombus template.

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  Fig. 3 Microscopic findings of the explanted heart. (A) Pathologic examination of the explanted heart revealed an inflammatory infiltration predominantly composed of T-cells and cardiomyocyte damage accompanied. (B) This inflammation was noted in the both atria and ventricles, and the interventricular septum. These findings were consistent with acute lymphocytic myocarditis. Furthermore, thrombi were noted in the lumen of the right coronary artery, and (C) nodal artery located adjacent the sinoatrial node. (D) The inflammatory cells were predominantly reactive for CD3, and many histiocytes were also noted.

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