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      Biopsy-proven Fulminant Myocarditis Requiring Mechanical Circulatory Support Following COVID-19 mRNA Vaccination

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          Abstract

          A 48-year-old woman suffered from cardiogenic shock with fulminant myocarditis following the second dose of COVID-19 vaccine (mRNA-1273). Venoarterial extracorporeal membrane oxygenation and Impella® support were essential in achieving hemodynamic stability. Endomyocardial biopsy revealed lymphocytic infiltration with predominant immunostaining for CD8 and CD68 positive cells. Left ventricular ejection fraction improved significantly after treatment with mechanical circulatory support. Myocarditis following COVID-19 mRNA vaccination may also occur in middle-aged women; it may be fulminant and require mechanical circulatory support. Although our results suggest the involvement of cytotoxic T lymphocytes and macrophages, further investigations are needed before establishing this pathogenetic mechanisms.

          Abstract

          A 48-year-old woman suffered from cardiogenic shock with fulminant myocarditis after receiving the second dose of COVID-19 vaccine (mRNA-1273). Endomyocardial biopsy revealed lymphocytic infiltration with predominant immunostaining for CD8 and CD68 positive cells. She was successfully treated using VA-ECMO and Impella® support. Cytotoxic T cells may be involved in the fulminant mechanisms of COVID-19 vaccine-related myocarditis.

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          Myocarditis With COVID-19 mRNA Vaccines

          Biykem Bozkurt, Ishan Kamat, Peter Hotez (2021)
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          Article 0 comments Cited 414 times – based on 0 reviews     Review now
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            Myocarditis after BNT162b2 mRNA Vaccine against Covid-19 in Israel

            Dror Mevorach, Emilia Anis, Noa Cedar … (2021)
            Background Approximately 5.1 million Israelis had been fully immunized against coronavirus disease 2019 (Covid-19) after receiving two doses of the BNT162b2 messenger RNA vaccine (Pfizer–BioNTech) by May 31, 2021. After early reports of myocarditis during adverse events monitoring, the Israeli Ministry of Health initiated active surveillance. Methods We retrospectively reviewed data obtained from December 20, 2020, to May 31, 2021, regarding all cases of myocarditis and categorized the information using the Brighton Collaboration definition. We analyzed the occurrence of myocarditis by computing the risk difference for the comparison of the incidence after the first and second vaccine doses (21 days apart); by calculating the standardized incidence ratio of the observed-to-expected incidence within 21 days after the first dose and 30 days after the second dose, independent of certainty of diagnosis; and by calculating the rate ratio 30 days after the second dose as compared with unvaccinated persons. Results Among 304 persons with symptoms of myocarditis, 21 had received an alternative diagnosis. Of the remaining 283 cases, 142 occurred after receipt of the BNT162b2 vaccine; of these cases, 136 diagnoses were definitive or probable. The clinical presentation was judged to be mild in 129 recipients (95%); one fulminant case was fatal. The overall risk difference between the first and second doses was 1.76 per 100,000 persons (95% confidence interval [CI], 1.33 to 2.19), with the largest difference among male recipients between the ages of 16 and 19 years (difference, 13.73 per 100,000 persons; 95% CI, 8.11 to 19.46). As compared with the expected incidence based on historical data, the standardized incidence ratio was 5.34 (95% CI, 4.48 to 6.40) and was highest after the second dose in male recipients between the ages of 16 and 19 years (13.60; 95% CI, 9.30 to 19.20). The rate ratio 30 days after the second vaccine dose in fully vaccinated recipients, as compared with unvaccinated persons, was 2.35 (95% CI, 1.10 to 5.02); the rate ratio was again highest in male recipients between the ages of 16 and 19 years (8.96; 95% CI, 4.50 to 17.83), with a ratio of 1 in 6637. Conclusions The incidence of myocarditis, although low, increased after the receipt of the BNT162b2 vaccine, particularly after the second dose among young male recipients. The clinical presentation of myocarditis after vaccination was usually mild.
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              Myocarditis after Covid-19 mRNA Vaccination

              Amanda Verma, Kory Lavine, Chieh-Yu Lin (2021)
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                Author and article information

                Journal
                Journal ID (nlm-ta): CJC Open
                Journal ID (iso-abbrev): CJC Open
                Title: CJC Open
                Publisher: Published by Elsevier Inc. on behalf of the Canadian Cardiovascular Society.
                ISSN (Electronic): 2589-790X
                Publication date PMC-release: 13 February 2022
                Publication date (Electronic): 13 February 2022
                Affiliations
                [a ]Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
                [b ]Division of Cardiology, Nagoya City East Medical Center, Nagoya, Japan
                Author notes
                [∗ ]Corresponding author: Takahiro Okumura, MD, PhD Department of Cardiology, Nagoya University Graduate School of Medicine 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan Tel: +81-52-744-2147; Fax: +81-52-744-2210;
                Article
                Publisher Item ID: S2589-790X(22)00029-4
                DOI: 10.1016/j.cjco.2022.02.004
                PMC ID: 8842092
                PubMed ID: 35187464
                SO-VID: 837b360e-4a63-44da-9603-7a435691f4c6
                Copyright © © 2022 Published by Elsevier Inc. on behalf of the Canadian Cardiovascular Society.
                License:

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                Date received : 8 November 2021
                Date revision received : 6 February 2022
                Date accepted : 8 February 2022
                Categories
                Subject: Case Report

                Keywords: myocarditis,covid-19,vaccination,cardiogenic shock,endomyocardial biopsy,covid-19, coronavirus disease 2019,va-ecmo, venoarterial extracorporeal membrane oxygenation,lvef, left ventricular ejection fraction,emb, endomyocardial biopsy
                Data availability:
                Keywords: myocarditis, covid-19, vaccination, cardiogenic shock, endomyocardial biopsy, covid-19, coronavirus disease 2019, va-ecmo, venoarterial extracorporeal membrane oxygenation, lvef, left ventricular ejection fraction, emb, endomyocardial biopsy

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