Lai Yi Wye, Chua Choon Guan, Lim Xin Rong, Francis Prabath Joseph, Xu Chuanhui, Howe Hwee Siew
Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore 308433, Singapore.
Department of Cardiology, Tan Tock Seng Hospital, Singapore 308433, Singapore.
Vaccines (Basel). 2022 Oct 21;10(10):1772. doi: 10.3390/vaccines10101772.
Since the introduction of coronavirus disease 2019 (COVID-19) messenger ribonucleic acid (mRNA) vaccines, there have been multiple reports of post-vaccination myocarditis (mainly affecting young healthy males). We report on four patients with active autoimmune rheumatic diseases (ARDs) and probable or confirmed myocarditis following COVID-19 mRNA vaccination managed at a tertiary hospital in Singapore; we reviewed the literature on post-COVID-19 mRNA vaccination-related myocarditis and ARD flares. Three patients had existing ARD flares (two had systemic lupus erythematosus (SLE), one had eosinophilic granulomatosis polyangiitis (EGPA)), and one had new-onset EGPA. All patients recovered well after receiving immunosuppressants comprising high-dose glucocorticoids, cyclophosphamide, and rituximab. Thus far, only one case of active SLE with myocarditis has been reported post-COVID-19 mRNA vaccination in the literature. In contrast to isolated post-COVID-19 mRNA vaccination myocarditis, our older-aged patients had myocarditis associated with ARD flares post-COVID-19 vaccination (that occurred after one dose of an mRNA vaccine), associated with other features of ARD flares, and required increased immunosuppression to achieve myocarditis resolution. This case series serves to highlight the differences in clinical and therapeutic aspects in ARD patients, heighten the vigilance of rheumatologists for this development, and encourage the adoption of risk reduction strategies in this vulnerable population.
自2019冠状病毒病（COVID-19）信使核糖核酸（mRNA）疫苗推出以来，已有多例接种疫苗后发生心肌炎的报告（主要影响年轻健康男性）。我们报告了在新加坡一家三级医院接受治疗的4例患有活动性自身免疫性风湿性疾病（ARD）且在接种COVID-19 mRNA疫苗后出现可能或确诊心肌炎的患者；我们回顾了关于接种COVID-19 mRNA疫苗后相关心肌炎和ARD病情加重的文献。3例患者出现现有ARD病情加重（2例患有系统性红斑狼疮（SLE），1例患有嗜酸性肉芽肿性多血管炎（EGPA）），1例出现新发EGPA。所有患者在接受包括大剂量糖皮质激素、环磷酰胺和利妥昔单抗的免疫抑制剂治疗后恢复良好。迄今为止，文献中仅报道了1例接种COVID-19 mRNA疫苗后出现活动性SLE合并心肌炎的病例。与单纯接种COVID-19 mRNA疫苗后发生的心肌炎不同，我们的老年患者在接种COVID-19疫苗后（在接种一剂mRNA疫苗后发生）出现与ARD病情加重相关的心肌炎，伴有ARD病情加重的其他特征，并且需要增加免疫抑制以解决心肌炎问题。这个病例系列旨在突出ARD患者在临床和治疗方面的差异，提高风湿病学家对这一情况的警惕性，并鼓励在这一脆弱人群中采取降低风险的策略。
