Case report: Case series of isolated acute pericarditis after SARS-CoV-2 vaccinations

Abstract

During the worldwide ongoing immunization campaign against SARS-CoV-2, growing data on very rare but potentially harmful side effects of such vaccines arise since approval trials have not been adequately powered to detect those events. Besides the already reported vaccine-related myocarditis, which primarily occurs in young male individuals, our attention was recently drawn to a series of older male and female patients, who were referred to our institutions with isolated acute pericarditis without myocardial damage, shortly after SARS-CoV-2 vaccination. We describe a series of five adult patients presenting with chest pain, shortness of breath and isolated pericarditis with and without pericardial effusion after SARS-CoV-2 vaccination. All patients underwent echocardiography and cardiac magnetic resonance, and the corresponding findings, including late gadolinium enhancement (LGE) and T1 and T2 mapping are reported herein. To our knowledge, such cases have not been systematically reported in the current literature so far.

Keywords: SARS-CoV-2 vaccination; T1 and T2 mapping; acute isolated pericarditis; cardiac troponins; isolated pericarditis after SARS-CoV-2 vaccination; late gadolinium enhancement.

Figure 1

Study flow chart.

Figure 2

Cardiac MRI images of patients #1–5. Cine images are displayed in (A–E). All patients showed pericardial LGE, which was either diffuse [(F,K) in patient #1; (G,L) in patient #2 and (H,M) in patient #3] or focal [(I, N) in patient #4 and (J,O) in patient #5], whereas myocardial LGE or elevated T1- and T2-values (P–Y) were not present with any of our patients. Pericardial and pleura effusion was present in patients #1–3. Patient #2 developed signs of a pericardial tamponade and underwent urgent pericardiocentesis (arrows depicting pericardial effusion and LGE in cases #1–3 and pericardial LGE without effusion in cases #4,5; asterisks pointing to the pleura effusions in cases #1–3).