Acute myopericarditis following administration of the BNT162b2 booster vaccine against COVID19

Acute myopericarditis following vaccine immunization is rare yet significant complication afflicting young adults in particular. Based on a paper published in JAMA on Oct 4th 2021, there were 15 cases of confirmed myocarditis in the vaccinated group (2 after the first dose and 13 after the second), for an observed incidence of 0.8 cases per 1 million first doses and 5.8 cases per 1 million second doses over a 10-day observation window.1

We report a case of a 18 year old Malay gentleman, with no past medical history, who had previously received 2 doses of the BNT162b2 vaccine in 2021 with no reported adverse reactions. On the 1st March 2022, he has received his 3rd (booster dose) of the BNT162b2 vaccine. Prior to receiving the vaccine patient reported that he was well. 48 h after receving the vaccine injection, patient started experiencing acute chest pain and fever. His temperature on arrival at the emergency department was 38 C. His vital signs were stable. ECG showed widespread saddle shaped ST elevations, and PR segments depressions in keeping with diagnosis of actue myopericarditis. His creatinine kinase levels were elevated at 874. Inflammatory markers were also elevated with a CRP of 72. RT PCR for Covid 19 was negative. Patient was started on high dose aspirin of 900 mg TDS and oral colchine 0.5 g TDS as treatment for acute pericarditis. Cardiac echocardiography was unremarkable showing good LV systolic function and absence of pericardial effusion. Cardiac MRI was performed 7 days after onset of symptoms which showed midwall LGE of at the basal inferior wall in keeping with myocarditis. Patient remained stable throughout his hospital stay and was hence managed conservatively.

This case illustrates the importance of clinicians to be aware of potential adverse cardiovascular adverse reactions following Covid vaccination such as acute myopericarditis. There is a need for further studies of large cohorts in order to establish accurate incidence rates and risk factors for developing such complications.