COVID-19-Induced Myocarditis and mRNA Vaccine-Related Pericarditis: A Case Report

Abstract

Acute inflammatory cardiac disease is an increasing cause of COVID-19 vaccine-induced complications. We report a case of acute pericarditis following the second dose of the COVID-19 vaccine (BNT162b2) in a 49-year-old woman with previous COVID-19-induced myocarditis and heart failure. A clinical presentation compatible with acute decompensated heart failure elevated troponin levels and a cardiac-MRI showing myocardial fibrosis and inflammatory pericardial effusion led to the diagnosis of perimyocarditis. She was treated with non-steroidal anti-inflammatory drugs (NSAIDs) and colchicine. Her condition improved in eight days. Physicians should be aware of the possible diagnosis of pericarditis and/or a myocardial injury after COVID-19 infection and vaccination.

Keywords: bnt162b2 mrna vaccine; covid 19; covid and myocarditis; heart failure; pericardial diseases; perimyocarditis.

Figure 1. CT pulmonary angiogram showing bilateral pleural effusion (arrows), larger in the right hemithorax.

Figure 2. Graph showing troponin levels during the patient’s admission

Patient's troponin levels reached peak at 4486.2 pg/mL on the second day's admission. At discharge, troponin was 870 pg/mL. Reference range is < 15.6 pg/mL.

Figure 3. Cardiac MRI performed during the patient’s admission showing areas of late gadolinium enhancement (fibrosis) in the basal septal and medial inferoseptal walls (arrows) in a non-vascular regional distribution pattern and pericardial effusion (asterisk).