Biopsy-Proven Fulminant Myocarditis Requiring Mechanical Circulatory Support Following COVID-19 mRNA VaccinationNovel Teaching Points
Shingo Kazama, MD,
Takahiro Okumura, MD, PhD,
Yuki Kimura, MD,
Ryota Ito, MD,
Takashi Araki, MD,
Takashi Mizutani, MD,
Hideo Oishi, MD,
Tasuku Kuwayama, MD, PhD,
Hiroaki Hiraiwa, MD, PhD,
Toru Kondo, MD, PhD,
Ryota Morimoto, MD, PhD,
Tomoaki Saeki, MD, PhD,
Toyoaki Murohara, MD, PhD
Affiliations
Shingo Kazama, MD
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Takahiro Okumura, MD, PhD
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Corresponding author: Dr Takahiro Okumura, Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan. Tel.: +81-52-744-2147; fax: +81-52-744-2210.
Yuki Kimura, MD
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Ryota Ito, MD
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Takashi Araki, MD
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Takashi Mizutani, MD
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Hideo Oishi, MD
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Tasuku Kuwayama, MD, PhD
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Hiroaki Hiraiwa, MD, PhD
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Toru Kondo, MD, PhD
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Ryota Morimoto, MD, PhD
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Tomoaki Saeki, MD, PhD
Division of Cardiology, Nagoya City East Medical Centre, Nagoya, Japan
Toyoaki Murohara, MD, PhD
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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. Résumé: Une femme de 48 ans a souffert d’un choc cardiogène accompagné d’une myocardite fulminante après avoir reçu la deuxième dose du vaccin contre la COVID-19 (ARNm-1273). L’oxygénation par membrane extracorporelle veino-artérielle et l’assistance par Impella ont joué un rôle essentiel pour atteindre la stabilité hémodynamique. Une biopsie endomyocardique a révélé la présence d’infiltrats lymphocytaires avec une immunocoloration prédominante pour les cellules exprimant CD8 et CD68. La fraction d’éjection ventriculaire gauche s’est améliorée considérablement après un traitement par assistance circulatoire mécanique. Des cas de myocardite peuvent également survenir chez des femmes d’âge moyen après l’administration d’un vaccin à ARNm contre la COVID-19; ils peuvent être fulminants et nécessiter une assistance circulatoire mécanique. Bien que nos résultats laissent croire à une participation des lymphocytes T cytotoxiques et des macrophages, une étude approfondie s’impose avant de pouvoir cerner les mécanismes pathogènes.
