Acute Myocarditis Following the Administration of the Second BNT162b2 COVID-19 Vaccine Dose

Saudi Arabia, Miqdad et al, 18 October 2021, Cureus

Summary

This is an 18-year-old male with no significant past medical history, presented to the emergency department complaining of central crushing chest pain four days following the second dose of the BNT162b2 COVID-19 vaccine. The pain was aggravated by respiration with no radiation or other associated symptoms. Upon admission, his vital signs were: Temperature 36.6 °C, pulse rate 74 beats/minute, blood pressure 120/65, O2 saturation 99%, and BMI 30.1. Cardiovascular and pulmonary examinations were unremarkable.

Initial ECG was normal with no apparent abnormalities, along with routine blood workup (Table 1), aside from mildly elevated high sensitivity troponin-I (2ng/ml) on arrival at the emergency room. However, while the initial ECG was unremarkable, the following ECG started to show ST-segment elevation (Figure 1) together with a gradual troponin-I elevation (Figure 2). Hence, the patient was admitted to the cardiac care unit for close cardiac monitoring and further workup, including diagnostic coronary angiography.

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Troponin-I trend during admission

Consequently, echocardiography showed normal global systolic left ventricular function with an estimated ejection fraction of 63%, along with normal right ventricular function and no valvular abnormalities. Diagnostic angiography revealed normal coronary arteries. Therefore, he was started on aspirin anti-inflammatory dose, colchicine, and proton pump inhibitors for a preliminary diagnosis of myocarditis. Additionally, cardiac MRI confirmed the diagnosis of myocarditis (Figure 3), with an estimated ejection fraction of 55%.

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Cardiac MRI
There is diffuse left ventricular myocardial edema with associated subpericardial enhancement pattern on delay acquisition. There is also severe global mild hypokinesia with no evidence of pericarditis or pericardial effusion.

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