Elghazal Mohamed, Alhudiri Inas M, Said Mohamed, Elhouderi Eiman, Elzagheid Adam
Vaccination Unit, Department of Cardiology, Libyan Biotechnology Research Center, Tripoli, LBY.
Department of Genetic Engineering, Libyan Biotechnology Research Center, Tripoli, LBY.
Cureus. 2023 Jan 31;15(1):e34452. doi: 10.7759/cureus.34452. eCollection 2023 Jan.
Myocarditis and pericarditis are inflammatory conditions affecting the myocardium and pericardium, respectively. They are caused by infectious and non-infectious conditions, including autoimmune disorders, drugs, and toxins. Vaccine-induced myocarditis has been reported with viral vaccines, including influenza and smallpox. The BNT162b2 mRNA vaccine (Pfizer-BioNTech) has shown great efficacy against symptomatic, severe coronavirus disease 2019 (COVID-19), hospital admissions, and deaths. The US FDA issued an emergency use authorization for the Pfizer-BioNTech COVID-19 mRNA vaccine for the prevention of COVID-19 in individuals ≥ five years. However, concerns were raised after reports of new cases of myocarditis following mRNA COVID-19 vaccines, especially among adolescents and young adults. Most cases developed symptoms after receiving the second dose. Here, we present a case of a previously healthy 34-year-old male who developed sudden and severe chest pain a week after the second dose of the Pfizer-BioNTech COVID-19 mRNA vaccine. Cardiac catheterization showed no angiographically obstructive coronary artery disease but it revealed intramyocardial bridging. This case report demonstrates that the mRNA COVID-19 vaccine can be associated with acute myopericarditis and the clinical presentation can mimic acute coronary syndrome. Despite that, acute myopericarditis associated with the mRNA COVID-19 vaccine is usually mild and can be managed conservatively. Incidental findings such as intramyocardial bridging should not exclude the diagnosis of myocarditis and should be carefully evaluated. COVID-19 infection has high mortality and morbidity even in young individuals, and all different COVID-19 vaccines were found effective in the prevention of severe COVID-19 infection and in decreasing COVID-19 mortality.
心肌炎和心包炎分别是影响心肌和心包的炎症性疾病。它们由感染性和非感染性因素引起，包括自身免疫性疾病、药物和毒素。已有报道称，流感和天花等病毒疫苗可引发疫苗诱导的心肌炎。BNT162b2信使核糖核酸（mRNA）疫苗（辉瑞-生物科技公司）已显示出对有症状的严重2019冠状病毒病（COVID-19）、住院和死亡具有显著疗效。美国食品药品监督管理局（FDA）已发布紧急使用授权，批准辉瑞-生物科技公司的COVID-19 mRNA疫苗用于预防5岁及以上人群的COVID-19。然而，在有报道称接种COVID-19 mRNA疫苗后出现新的心肌炎病例后，人们产生了担忧，尤其是在青少年和年轻人中。大多数病例在接种第二剂疫苗后出现症状。在此，我们报告一例先前健康的34岁男性，在接种第二剂辉瑞-生物科技公司的COVID-19 mRNA疫苗一周后突然出现严重胸痛。心导管检查显示冠状动脉造影无阻塞性冠状动脉疾病，但发现有心肌桥。本病例报告表明，COVID-19 mRNA疫苗可能与急性心肌心包炎有关，其临床表现可类似于急性冠状动脉综合征。尽管如此，与COVID-19 mRNA疫苗相关的急性心肌心包炎通常较轻，可采用保守治疗。诸如心肌桥等偶然发现不应排除心肌炎的诊断，应仔细评估。即使在年轻人中，COVID-19感染也具有高死亡率和高发病率，并且已发现所有不同的COVID-19疫苗在预防严重COVID-19感染和降低COVID-19死亡率方面均有效。
