Published online Apr 26, 2022. doi: 10.5495/wjcid.v12.i1.33
Peer-review started: July 2, 2021
First decision: October 18, 2021
Revised: November 13, 2021
Accepted: January 25, 2022
Article in press: January 25, 2022
Published online: April 26, 2022
Coronavirus disease 2019 (COVID-19) is a highly contagious viral illness which conventionally manifests with primarily respiratory symptoms and less commonly with cardiac involvement in various forms, such as pericarditis. Myocarditis and pericarditis have been reported in a variety of live and attenuated vaccines, such as smallpox and influenza. As of October 2021, no cases of pericarditis associated with COVID-19 vaccination have been published. We present two healthy male patients who present post COVID-19 vaccination with pericarditis diagnoses.
A 21-year-old male with no significant past medical history presented with myalgia, chills, mild headache, and chest pain for two days. Patient received the Moderna COVID-19 vaccine the day prior to symptom onset. On presentation, electrocardiogram (ECG) revealed sinus rhythm with ST elevation, and troponin was elevated. Emergent cardiac catheterization was not significant for abnormalities. The primary diagnosis was acute pericarditis, and the patient was discharged on colchicine and indomethacin. Additionally, a 35-year-old male with no pertinent past medical history presented with fever, chills, weakness, nausea, vomiting, diarrhea, and retrosternal chest pain for three days. He received the Moderna COVID-19 vaccine four days prior to symptom onset. On presentation, troponin was elevated, and ECG revealed mild ST elevation. Left ventricular dysfunction with ejection fraction of 41% was reported on transthoracic echocardiogram. Patient was started on ibuprofen and colchicine for diagnosis of myopericarditis.
These case reports highlight a potential unintended consequence, pericarditis, associated with COVID-19 vaccination that may not warrant invasive cardiac intervention.
Core Tip: Coronavirus disease 2019 (COVID-19) manifests with primarily respiratory symptoms and less commonly with cardiac involvement. Myocarditis and pericarditis have been reported in a variety of live and attenuated vaccines. However, to our knowledge, there are no published cases associated with COVID-19 vaccination as of October 2021. We present two cases of pericarditis following COVID-19 vaccination. Both patients were treated with colchicine and non-steroidal anti-inflammatory agents but with varying degrees of invasive work-up. The first patient had emergent cardiac catheterization, while the second patient underwent computed tomographic angiography of the coronary arteries. Neither patient required intervention, thus questioning the necessity of cardiac catheterization.