Regional Cardiovascular Disease Center, Chungbuk National University Hospital, Cheongju, Korea.
Division of Cardiology, Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea.
J Korean Med Sci. 2022 May 30;37(21):e169. doi: 10.3346/jkms.2022.37.e169.
With the global spread of severe acute respiratory syndrome coronavirus 2, several vaccines were developed; messenger RNA (mRNA) vaccines have recently been widely used worldwide. However, the incidence of myocarditis following mRNA vaccination is increasing; although the cause of myocarditis has not yet been clearly identified, it is presumed to be caused by a problem in the innate immune system. Immune-mediated thrombocytopenia (ITP) after vaccination is rare but has been reported and is also assumed to occur by the same mechanism. We report the first case of simultaneous myocarditis and ITP after mRNA vaccination. A 38-year-old woman presented with chest pain, mild dyspnea, and sweating after vaccination with mRNA-1273 vaccine (Moderna) 4 days prior to admission. Upon admission to the emergency department, cardiac enzymes were elevated; blood test performed 5 months ago showed normal platelet count, but severe thrombocytopenia was observed upon admission. After administration of intravenous immunoglobulin, the platelet count improved; subsequently, myocarditis was observed on endomyocardial biopsy. Thus, myocarditis and ITP were judged to have occurred simultaneously due to the expression of the innate immune system markers after mRNA vaccination. The patient was discharged on day 6 of admission.
随着严重急性呼吸综合征冠状病毒 2 在全球范围内的传播，已经开发出了几种疫苗；信使 RNA（mRNA）疫苗最近在全球范围内广泛使用。然而，mRNA 疫苗接种后心肌炎的发病率正在增加；尽管心肌炎的病因尚未明确，但据推测是由固有免疫系统的问题引起的。接种疫苗后发生免疫介导的血小板减少症（ITP）很少见，但已有报道，并且也被认为是通过相同的机制发生的。我们报告了首例 mRNA 疫苗接种后同时发生心肌炎和 ITP 的病例。一名 38 岁女性在接种 mRNA-1273 疫苗（Moderna）4 天前出现胸痛、轻度呼吸困难和出汗，随后被收入院。入院时，心肌酶升高；5 个月前进行的血液检查显示血小板计数正常，但入院时发现严重血小板减少症。静脉注射免疫球蛋白后，血小板计数改善；随后在心肌活检中观察到心肌炎。因此，由于 mRNA 疫苗接种后固有免疫标志物的表达，判断心肌炎和 ITP 同时发生。患者在入院第 6 天出院。
