Fulminant Myocarditis 24 Days after Coronavirus Disease Messenger Ribonucleic Acid Vaccination

Hiroaki Kawano; Tetsufumi Motokawa; Hirokazu Kurohama; Shinji Okano; Ryohei Akashi; Tsuyoshi Yonekura; Satoshi Ikeda; Koichi Izumikawa; Koji Maemura

doi:10.2169/internalmedicine.9800-22

CASE REPORTS

Fulminant Myocarditis 24 Days after Coronavirus Disease Messenger Ribonucleic Acid Vaccination

Hiroaki Kawano, Tetsufumi Motokawa, Hirokazu Kurohama, Shinji Okano, Ryohei Akashi, Tsuyoshi Yonekura, Satoshi Ikeda, Koichi Izumikawa, Koji Maemura

Author information

Hiroaki Kawano
Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
Tetsufumi Motokawa
Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
Hirokazu Kurohama
Department of Pathology, Nagasaki University Hospital, Japan
Shinji Okano
Department of Pathology, Nagasaki University Hospital, Japan
Ryohei Akashi
Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
Tsuyoshi Yonekura
Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
Satoshi Ikeda
Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
Koichi Izumikawa
Infection Control and Education Center, Nagasaki University Hospital, Japan
Koji Maemura
Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan

Keywords: biopsy, pathology, inflammation

JOURNAL OPEN ACCESS

2022 Volume 61 Issue 15 Pages 2319-2325

DOI https://doi.org/10.2169/internalmedicine.9800-22

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Abstract

A 60-year-old Japanese woman was hospitalized for cardiogenic shock 24 days after receiving the second dose of the coronavirus disease 2019 BNT162b2 vaccine. Impella CP left ventricular assist device implantation and venoarterial peripheral extracorporeal membranous oxygenation were immediately initiated along with inotropic support and steroid pulse therapy, as an endomyocardial biopsy specimen showed myocarditis. Three weeks later, her cardiac function had recovered, and she was discharged. An immune response associated with the presence of spike protein in cardiac myocytes may be related to myocarditis in the present case because of positive immunostaining for severe acute respiratory syndrome coronavirus 2 spike protein and C4d in the myocardium.

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