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Case Reports
. 2022 Feb 17:23:e934399.
doi: 10.12659/AJCR.934399.

Myocarditis, Pulmonary Hemorrhage, and Extensive Myositis with Rhabdomyolysis 12 Days After First Dose of Pfizer-BioNTech BNT162b2 mRNA COVID-19 Vaccine: A Case Report

Sara Al-Rasbi  1   2 , Juhaina Salim Al-Maqbali  3 , Rajaa Al-Farsi  2 , Moza Ali Al Shukaili  4 , Maryam H Al-Riyami  2 , Zubaida Al Falahi  1 , Hatem Al Farhan  1   2 , Abdullah M Al Alawi  1   2
Affiliations
Case Reports

Myocarditis, Pulmonary Hemorrhage, and Extensive Myositis with Rhabdomyolysis 12 Days After First Dose of Pfizer-BioNTech BNT162b2 mRNA COVID-19 Vaccine: A Case Report

Sara Al-Rasbi et al. Am J Case Rep. .

Abstract

BACKGROUND The COVID-19 pandemic is a current global crisis, and there are hundreds of millions of individuals being vaccinated worldwide. At present, there have been few reports of COVID-19 vaccine-induced autoimmune processes manifested as myositis, thrombocytopenia, and myocarditis. CASE REPORT A 37-year-old man presented to the Emergency Department (ED) with a 3-day history of back pain and a 1-day history of left upper limb swelling with paresthesia and shortness of breath, 12-days after receiving the first dose of Pfizer/BioNTech BNT162b2 mRNA COVID-19 vaccine. He was diagnosed with severe myositis complicated with rhabdomyolysis and non-oliguric acute kidney injury, thrombocytopenia, myocarditis with pulmonary edema, and pulmonary hemorrhage. Screens for potential toxic, infectious, paraneoplastic, and autoimmune disorders were unremarkable. The patient was treated with a 5-day course of intravenous methylprednisolone and intravenous immunoglobulin, with a good response. He was hospitalized for 16 days and discharged home on a tapering dose of oral prednisolone for 6 weeks. CONCLUSIONS The case describes a possible link between Pfizer/BioNTech BNT162b2 mRNA COVID-19 vaccine and immune-mediated myocarditis, pulmonary vasculitis, myositis, and thrombocytopenia. However, further data are required to confirm such an association.

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Conflict of interest statement

Conflict of interest: None declared

Figures

Figure 1.
Figure 1.
Twelve-lead electrocardiography obtained on the day of presentation.
Figure 2.
Figure 2.
Chest X-ray on day of presentation showing extensive bilateral pulmonary infiltrates (red arrows).
Figure 3.
Figure 3.
Chest computed tomography with contrast showing extensive bilateral ground-glass and patchy nodular opacities, more on the left lung (red arrows).
Figure 4.
Figure 4.
Echocardiogram at presentation demonstrating the following views: (A1) 4-chamber view in diastole; (A2) 4-chamber view in systole; (B1) parasternal long-axis view in diastole; (B2) parasternal long-axis view in systole; (C1) parasternal short axis view in diastole; and (C2) parasternal short axis view in systole.
Figure 5.
Figure 5.
Magnetic resonance imaging T2 fat-suppressed axial sequence of the left shoulder with diffuse subcutaneous edema and abnormal signal intensity of deltoid muscle, infraspinatus, and supraspinatus muscles, likely representing myositis changes (red arrow).
Figure 6.
Figure 6.
Trend of troponin T (ng/L) during hospitalization.
Figure 7.
Figure 7.
Trend of creatine kinase levels (U/L) during hospitalization.
Figure 8.
Figure 8.
Trend of serum creatinine levels (µmol/L) and platelet counts (109/L) during hospitalization.
See this image and copyright information in PMC

References

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