A Case of Systemic Capillary Leak Syndrome With Severe Cardiac Dysfunction After mRNA Vaccination for COVID-19Novel Teaching Points
Takashi Araki, MD,
Ryota Morimoto, MD, PhD,
Ryota Ito, MD,
Takashi Mizutani, MD,
Yuki Kimura, MD,
Shingo Kazama, MD,
Hideo Oishi, MD,
Tasuku Kuwayama, MD, PhD,
Hiroaki Hiraiwa, MD, PhD,
Toru Kondo, MD, PhD,
Takahiro Okumura, MD, PhD,
Toyoaki Murohara, MD, PhD
Affiliations
Takashi Araki, MD
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Ryota Morimoto, MD, PhD
Corresponding author: Dr Ryota Morimoto, Department of Cardiology, Nagoya University Graduate School of Medicine. 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan. Tel.: +81-52-744-2147; fax: +81-52-744-2210.; 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 Mizutani, MD
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Yuki Kimura, MD
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Shingo Kazama, 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
Takahiro Okumura, MD, PhD
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Toyoaki Murohara, MD, PhD
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
A 53-year-old woman with no significant medical history developed cardiogenic shock 4 days after receiving the second dose of the COVID-19 mRNA vaccine (BNT162b2, Pfizer/BioNtech). The patient required extracorporeal membrane oxygenation and an Impella device. Based on significant hemoconcentration, decreased plasma protein levels, and pathologic findings in myocardial specimens, the patient was diagnosed with vaccination-induced fulminant systemic capillary leak syndrome (SCLS) with severe cardiac dysfunction. This case highlights that SCLS can occur after COVID-19 mRNA vaccination and may be associated with cardiac dysfunction. In patients with cardiogenic shock, hemoconcentration, and hypoalbuminemia after vaccination, SCLS should be considered. Résumé: Une femme de 53 ans sans antécédents médicaux significatifs a subi un choc cardiogénique quatre jours après avoir reçu la deuxième dose du vaccin à ARNm contre la COVID-19 (BNT162b2, Pfizer/BioNtech). Elle a eu besoin d’une oxygénation extracorporelle et d’un dispositif d’assistance Impella. Compte tenu de l’hémoconcentration importante, des taux inférieurs de protéines plasmatiques et d’observations pathologiques sur les échantillons myocardiques, la patiente a reçu un diagnostic de syndrome de fuite capillaire systémique (SFCS) fulminant provoqué par la vaccination avec dysfonction cardiaque sévère. Ce cas montre que le SFCS, parfois associé à une dysfonction cardiaque, peut survenir après l’administration du vaccin à ARNm contre la COVID-19. Un SFCS doit donc être soupçonné chez les patients présentant un choc cardiogénique, une hémoconcentration et une hypoalbuminémie après la vaccination.
