Department of Medicine, Tufts Medical Center, Boston, Massachusetts, USA.
Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, Massachusetts, USA.
BMJ Case Rep. 2021 Nov 30;14(11):e246059. doi: 10.1136/bcr-2021-246059.
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.
一名 38 岁男性在接种第一剂 mRNA-1273 疫苗 8 天后出现数天胸痛和呼吸急促。患者在低血压和心源性休克的情况下新出现左心室射血分数为 10%，需要使用轴流导管泵进行机械支持。该表现提示近期 mRNA-1273 疫苗引起的炎症反应导致急性暴发性心肌炎。患者接受了 3 天脉冲剂量类固醇治疗，最终导致血流动力学恢复并移除机械循环支持。进行了心内膜心肌活检，显示局灶性淋巴细胞间质浸润，伴有心肌损伤，符合淋巴细胞性心肌炎。患者的心脏功能有所改善，在连续影像学检查中可见。
