2021년 제72차 대한내과학회 추계학술대회 211
￭S-171 ￭ Myocarditis following immunization with mRNA COVID-19 vaccine
강북삼성병원 순환기내과
김현아, 이승재
Background: Mass vaccination have been initiated to contain the ongoing Coronavirus disease 2019 (COVID-19) pandemic. Recently, myocarditis has been reported as a rare complication of COVID-19 messenger RNA (mRNA) vaccinations, predominantly in young adult and adolescent males.
Case: An 18-year-old man with no medical history presented to the emergency room for acute anterior chest pain. He was given the first dose of COVID-19 mRNA vaccination 5 days ago and there were no adverse effects before chest pain appeared. The physical examination revealed blood pressure of 107/57 mmHg, heart rate of 96 beats/min, oxygen saturation of 98% while breathing ambient air, and body temperature of 36.7°C. Laboratory findings showed an increase in C-reactive protein (CRP) level (10.63mg/dL) with normal leucocytes (6.33 × 10³/㎣) and highly elevated CK-MB and high sensitive troponin I (hsTnI) level (97.30ng/mL, 49507.03pg/mL respectively). The electrocardiogram (ECG) showed diffuse ST-segment elevation. Transthoracic echocardiography showed the left ventricular ejection fraction (LVEF) at 51% with hypokinesia at all apex wall and small amount of pericardial effusion. Coronary angiogram showed normal coronary artery and ergonovine provocation test was negative. Cardiac magnetic resonance imaging (MRI) demonstrated subepicardial nodular and linear late gadolinium enhancement at inferolateral wall. Testing for usual viruses that cause myocarditis was negative. After he was treated with antibiotics and steroids, clinical symptoms improved and progressively hsTnI and CRP reduced to 0.79 ng/mL, 2649.00 pg/mL respectively.
Discussion: The mechanisms that cause myocarditis following vaccination with an mRNA COVID-19 vaccine are not clear. Despite rare complications of myocarditis, the benefit-risk assessment for COVID-19 vaccination demonstrate a favorable balance for all age and sex groups. Therefore COVID-19 vaccination is recommended. But further research is needed to determine associations of mRNA COVID-19 vaccination and myocarditis.
