key: cord-0852516-mkt0oz7s
authors: Isaak, Alexander; Feisst, Andreas; Luetkens, Julian A.
title: Myocarditis Following COVID-19 Vaccination
date: 2021-08-03
journal: Radiology
DOI: 10.1148/radiol.2021211766
sha: 0d3f2f0c5ab8f7a71f815d55c6d22e50282924c5
doc_id: 852516
cord_uid: mkt0oz7s

nan

A healthy 15-year-old boy received his second vaccination dose (BNT162b2-mRNA SARS-CoV2, Biontech/Pfizer) and the following day he developed fever, myalgia, and intermittent tachycardia. At presentation to the hospital his electrocardiogram showed ST-segment elevation in the left precordial leads. High-sensitive cardiac troponin and C-reactive protein levels were elevated. Serology tests for cardiotropic viruses were negative. Transthoracic echocardiography showed normal myocardial function without wall motion abnormalities. Cardiac MRI at 1.5 T showed a normal left ventricular size, normal left ventricular ejection fraction and a small pericardial effusion. T2-weighted short TI inversion recovery sequences displayed focal myocardial edema involving the lateral wall, most emphasized in the basal inferolateral segment ( Figure) . Corresponding subepicardial enhancement was detected by late gadolinium enhancement imaging indicating inflammatory necrosis ( Figure) . Quantitative myocardial mapping parameters were elevated confirming the qualitatively assessed findings (Figure) .

The 2018 Lake Louise criteria for the diagnosis of an acute myocarditis were fulfilled (1, 2).

Furthermore, vaccine-induced unilateral axillary lymphadenopathy was also observed. Due to the close temporal relation between the mRNA SARS-CoV-2 vaccination and the onset of symptoms (one day), vaccine-induced hypersensitivity myocarditis was clinical diagnosis. The patient was discharged in stable condition after 7 days of hospitalization.

Cardiac MRI characteristics of vaccine-induced hypersensitivity myocarditis are similar to other virusinduced causes of myocarditis. This case shows that clinicians should be aware of vaccine-induced myocarditis as a possible adverse effect in children with thoracic/cardiovascular complaints after mRNA SARS-CoV-2-vaccination. As children are now scheduled to be vaccinated in many countries, cases of vaccine-induced myocarditis will have been noted in association with mRNA vaccines. Vaccine associated myocarditis is rare, but more common in the young population, especially in males (e.g. 

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