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

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.

Keywords: Adverse Effects; COVID-19; Male; Myopericarditis; Pfizer-BioNTech Vaccine.

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.