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Case Reports
. 2023 Feb;19(2):114-116.
doi: 10.1016/j.reuma.2022.06.003. Epub 2022 Jul 28.

Systemic lupus erythematosus myocarditis after COVID-19 vaccination

Miguel Sogbe  1 , Andrés Blanco-Di Matteo  1 , I Madeleine Di Frisco  2 , Juan Fernando Bastidas  3 , Nahikari Salterain  4 , Juan José Gavira  4
Affiliations
Free PMC article
Case Reports

Systemic lupus erythematosus myocarditis after COVID-19 vaccination

Miguel Sogbe et al. Reumatol Clin. 2023 Feb.
Free PMC article

Abstract
in English, Spanish

Introduction: Cases of acute myocarditis have been after administration of the BNT162b2 and Ad26.COV2.S vaccine.

Objective: Describe another possible mechanism of myocarditis after COVID-19 vaccination.

Case presentation: We describe the clinical case of a 72-year-old female with pleuritic chest pain one week after the third of the BNT162b2 mRNA vaccine. Serological tests for cardiotropic pathogens were negative, and autoimmunity screening was positive with anti-nuclear antibody (ANA) in 1:160 dilution, Anti-double-stranded DNA (anti-dsDNA), and anti-histone antibodies. 18F-fluoro-deoxy-glucose (FDG) positron emission tomography/computed tomography (PET/CT) showed a focal myocardial and pericardial inflammatory process in the cardiac apex.

Results and discussion: Systemic lupus erythematosus (SLE) diagnosis was made with myocardial affection. As far as we know, this is the first report of a case of lupus myocarditis after the COVID-19 vaccine.

Conclusion: Given the pathogenic rationales, the association between SLE and myocarditis should be considered.

Introducción: Se han presentado casos de miocarditis aguda tras la administración de las vacunas BNT162b2 y Ad26.COV2.S.

Objetivo: Describir otro posible mecanismo de miocarditis posterior a la vacunación contra el COVID-19.

Presentación del caso: Describimos el caso clínico de una mujer de 72 años con dolor torácico pleurítico una semana después de la tercera vacuna de ARNm BNT162b2. Las pruebas serológicas para patógenos cardiotrópos fueron negativas y el cribado de autoinmunidad fue positivo con anticuerpos antinucleares (ANA) en dilución 1:160, anticuerpos anti-ADN de doble cadena (anti-dsADN) y antihistonas. La tomografía por emisión de positrones/tomografía computarizada (PET/TC) con 18F-fluorodesoxiglucosa (FDG) mostró un proceso inflamatorio miocárdico y pericárdico focal en el ápex cardíaco.

Resultados y discusión: Se realizó el diagnóstico de lupus eritematoso sistémico (LES) con afectación miocárdica. Hasta donde sabemos, este es el primer reporte de un caso de miocarditis lúpica después de la vacuna contra el COVID-19.

Conclusión: Dadas las justificaciones patogénicas, se debe considerar la asociación entre lupus eritematoso sistémico (LES) y miocarditis.

Keywords: BNT162B2 messenger RNA; COVID-19 vaccination; Myocarditis; Systemic lupus erythematosus.

Figures

Figure 1
Figure 1
PET/CT with 18F-FDG. Anterior view of the whole-body MIP (maximum intensity projection) image, showing a hot spot on the myocardial apex (white arrows) (A); in coronal (B), sagittal (C) and axial (D) fused images of the PET/CT scan.
See this image and copyright information in PMC

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