Acute Fulminant Myocarditis Following Influenza Vaccination Requiring Extracorporeal Membrane Oxygenation

Abstract

The inactivated influenza vaccination is generally safe with mostly mild side effects. We report a rare but fatal adverse event following influenza vaccination. A previously healthy 27-year-old woman who received the influenza vaccination 3 days before presenting to the emergency department had rapidly aggravating dyspnea and mental deterioration. She was diagnosed as having acute fulminant myocarditis with refractory cardiogenic shock, which was successfully managed with veno-arterial extracorporeal membrane oxygenation. The cardiac function of the patient recovered in 3 weeks.

Keywords: adverse event; cardiogenic shock; extracorporeal membrane oxygenation; influenza vaccines; myocarditis.

Figure 1.

Serial changes of vital signs and lactic acid level for 10 hours after emergency department (ED) presentation. ECMO: extracorporeal membrane oxygenation; ICU: intensive care unit.

Figure 2.

Serial chest X-rays during hospitalization. (A) Chest X-ray showed diffuse ground glass opacities on both lung fields at 4 hours after emergency department presentation. (B) Chest X-ray after insertion of extracorporeal membrane oxygenation and intubation at emergency department. (C) Chest X-ray after recovery on the 9th day of hospitalization.

Figure 3.

Representative cardiovascular magnetic resonance findings in a patient with acute myocarditis. (A) Short-axis T2 map revealed an increased global myocardial T2 value of 68–72 ms in this patient. (B) Late gadolinium enhancement shows mild diffuse midwall enhancement in the left ventricular (LV) myocardium.