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Multimodality imaging and histopathology in a young man presenting with fulminant lymphocytic myocarditis and cardiogenic shock after mRNA-1273 vaccination
  1. Mazhar Kadwalwala1,
  2. Bhawneet Chadha1,
  3. Jamel Ortoleva2 and
  4. Maurice Joyce2
  1. 1Department of Medicine, Tufts Medical Center, Boston, Massachusetts, USA
  2. 2Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, Massachusetts, USA
  1. Correspondence to Dr Maurice Joyce; mjoyce{at}tuftsmedicalcenter.org

Abstract

A 38-year-old man presented with several days of chest pain and shortness of breath 8 days after receiving the first dose of an mRNA-1273 vaccine. The patient was found to have new left ventricular ejection fraction of 10% in the setting of hypotension and cardiogenic shock requiring mechanical support with an axial flow catheter pump. The presentation was concerning for acute fulminant myocarditis secondary to an inflammatory response from the recent mRNA-1273 vaccine. The patient was treated with pulse dose steroids for 3 days, ultimately leading to haemodynamic recovery and removal of mechanical circulatory support. Endomyocardial biopsy was performed and showed focal lymphocytic interstitial infiltrate with myocyte damage consistent with lymphocytic myocarditis. The patient had improvement of cardiac function which was seen on serial imaging.

  • heart failure
  • COVID-19
  • immunological products and vaccines
  • global health
  • adult intensive care

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Footnotes

  • Contributors All authors (BC, MK, JO, MJ) contributed equally to the conception of the case report, data collection, drafting of the case report, critical revision of the case report and final approval of the submitted case report.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.