Biopsy-Proven Fulminant Myocarditis Requiring Mechanical Circulatory Support Following COVID-19 mRNA Vaccination

• DOI: 10.1016/j.cjco.2022.02.004
• Publication Date: 2022-02-13T22:26:57Z
• Authors: Shingo Kazama; Takahiro Okumura; Yuki Kimura; Ryota Ito; Takashi Araki; Takashi Mizutani; Hideo Oishi; Tasuku Kuwayama; Hiroaki Hiraiwa; Toru Kondo; Ryota Morimoto; Tomoaki Saeki; Toyoaki Murohara
• Keywords: 03 medical and health sciences; 0302 clinical medicine; Case Report

A 48-year-old woman suffered from cardiogenic shock with fulminant myocarditis following the second dose of COVID-19 vaccine (mRNA-1273). Venoarterial extracorporeal membrane oxygenation and Impella support were essential in achieving hemodynamic stability. Endomyocardial biopsy revealed lymphocytic infiltration with predominant immunostaining for CD8- and CD68-positive cells. The left ventricular ejection fraction improved significantly after treatment with mechanical circulatory support. Myocarditis following COVID-19 mRNA vaccination may also occur in middle-aged women; it may be fulminant and require mechanical circulatory support. Although our results suggest the involvement of cytotoxic T lymphocytes and macrophages, further investigation is needed before these can be established as pathogenetic mechanisms.