Department of Pediatrics, Jichi Medical University.
Tohoku J Exp Med. 2022 Oct 25;258(3):177-182. doi: 10.1620/tjem.2022.J068. Epub 2022 Aug 25.
Perimyocarditis is a rare and serious cardiac complication following COVID-19 vaccination. Young males are most at risk after the second dose. With the introduction of the booster (third) dose, some reports have focused on the risk of perimyocarditis after a booster dose. However, no currently available report in Japan has comprehensively described this phenomenon. A healthy 14-year-old Japanese male, who had completed a two-dose primary series of the BNT162b2 (Pfizer-BioNTech) vaccine six months prior, developed fever and chest pain within 24 hours after a homologous booster dose. He was transferred to our institute because of worsening chest pain. A multiplex PCR test showed no evidence of active viral infections, including SARS-CoV-2. Electrocardiography revealed ST-segment elevation in almost all leads, suggesting pericarditis. Echocardiography showed normal systolic function. Laboratory data demonstrated C-reactive protein levels of 8.8 mg/dL and elevated cardiac damage markers (troponin T, 1.9 ng/mL; creatine phosphokinase, 1527 U/L; MB isoenzyme, 120 U/L), suggesting myocarditis. He was diagnosed with perimyocarditis associated with the booster dose, which was confirmed by cardiac magnetic resonance imaging four days after initial symptoms. Chest pain improved spontaneously along with a resolution of electrocardiographic findings and laboratory data within several days. He was discharged eight days after admission. Perimyocarditis is less frequent after a booster dose than after primary doses. In this case, the patient with booster-dose-associated perimyocarditis showed favorable clinical course without severe sequelae. The patient's clinical course was consistent with findings on previous large-scale reports on primary-dose-associated perimyocarditis and case series on booster-dose-associated perimyocarditis.
心肌炎是 COVID-19 疫苗接种后的一种罕见且严重的心脏并发症。在第二剂后，年轻男性的风险最高。随着加强针（第三剂）的推出，一些报告集中在加强针后心肌炎的风险上。然而，目前在日本还没有全面描述这种现象的报告。一名健康的 14 岁日本男性，在六个月前完成了两剂 BNT162b2（辉瑞-生物科技）疫苗的基础接种系列，在同源加强针接种后 24 小时内出现发热和胸痛。由于胸痛恶化，他被转至我院。多重 PCR 检测未显示出包括 SARS-CoV-2 在内的活跃病毒感染的证据。心电图显示几乎所有导联 ST 段抬高，提示心包炎。超声心动图显示收缩功能正常。实验室数据显示 C-反应蛋白水平为 8.8mg/dL，且心脏损伤标志物（肌钙蛋白 T，1.9ng/mL；肌酸磷酸激酶，1527U/L；MB 同工酶，120U/L）升高，提示心肌炎。他被诊断为与加强针相关的心肌炎，这在初始症状后四天的心脏磁共振成像中得到证实。胸痛自发改善，心电图发现和实验室数据在几天内得到解决。他在入院后第八天出院。心肌炎在加强针后比基础剂量后少见。在这种情况下，与加强针相关的心肌炎患者表现出良好的临床过程，没有严重的后遗症。该患者的临床过程与之前关于基础剂量相关心肌炎的大规模报告和关于加强针相关心肌炎的病例系列一致。
