Kazama Shingo, Okumura Takahiro, Kimura Yuki, Ito Ryota, Araki Takashi, Mizutani Takashi, Oishi Hideo, Kuwayama Tasuku, Hiraiwa Hiroaki, Kondo Toru, Morimoto Ryota, Saeki Tomoaki, Murohara Toyoaki
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Division of Cardiology, Nagoya City East Medical Centre, Nagoya, Japan.
CJC Open. 2022 May;4(5):501-505. doi: 10.1016/j.cjco.2022.02.004. Epub 2022 Feb 13.
A 48-year-old woman suffered from cardiogenic shock with fulminant myocarditis following the second dose of COVID-19 vaccine (mRNA-1273). Venoarterial extracorporeal membrane oxygenation and Impella support were essential in achieving hemodynamic stability. Endomyocardial biopsy revealed lymphocytic infiltration with predominant immunostaining for CD8- and CD68-positive cells. The left ventricular ejection fraction improved significantly after treatment with mechanical circulatory support. Myocarditis following COVID-19 mRNA vaccination may also occur in middle-aged women; it may be fulminant and require mechanical circulatory support. Although our results suggest the involvement of cytotoxic T lymphocytes and macrophages, further investigation is needed before these can be established as pathogenetic mechanisms.
一名48岁女性在接种第二剂新冠病毒疫苗（mRNA-1273）后出现暴发性心肌炎并伴有心源性休克。静脉-动脉体外膜肺氧合和Impella支持对于实现血流动力学稳定至关重要。心内膜心肌活检显示淋巴细胞浸润，主要为CD8和CD68阳性细胞免疫染色。机械循环支持治疗后左心室射血分数显著改善。新冠病毒mRNA疫苗接种后心肌炎也可能发生在中年女性中；可能是暴发性的，需要机械循环支持。尽管我们的结果提示细胞毒性T淋巴细胞和巨噬细胞参与其中，但在将这些确立为发病机制之前还需要进一步研究。
