An important update on the Brown University student myopericarditis case described here.
Despite an effective “gag order” on discussion of this case (see Brown Cardiology Division Chief email 8/1/22: Poppas email 8.1.22 redacted), and its implications vis-à-vis Brown University’s ongoing covid-19 vaccination requirement for incoming freshmen, Dr. Yash Patel et al of the Cardiology Division published a description of the case on September 9, 2021.
–Healthy 20 year old white male hospitalized in Rhode Island
–Diagnosed with myopericarditis ~3 days after second Pfizer mRNA vaccine injection
–Left ventricular ejection fraction (LVEF) of 51% by transthoracic echocardiography
— Magnetic resonance imaging showing subepicardial and mid-myocardial late gadolinium enhancement in the basal, mid, and apical lateral segments accompanied by myocardial edema in mid and apical lateral segments on T2-weighted images
— SARS COVID-19 PCR testing, other viral serologies, and bacterial testing all negative
Published: 09 September 2021; “Cardiovascular magnetic resonance findings in young adult patients with acute myocarditis following mRNA COVID-19 vaccination: a case series” Yash R. Patel, David W. Louis, Michael Atalay, Saurabh Agarwal & Nishant R. Shah. Journal of Cardiovascular Magnetic Resonance volume 23, Article number: 101 (2021)
“A 20-year-old male with no known health problems presented to the emergency department with chest pain and dyspnea 3 days after receiving his second dose of the Pfizer COVID-19 vaccine. A 12-lead ECG showed diffuse PR segment depression and PR segment elevation in lead aVR, consistent with acute pericarditis. On admission, serum troponin I was elevated at 58 pg/ml. SARS COVID-19 PCR testing, other viral serologies, and bacterial testing were all negative. TTE showed a borderline depressed LVEF (Left Ventricular Ejection Fraction) of 51% and no pericardial effusion. CT coronary angiography showed no coronary artery calcification and non-obstructive coronary artery disease. CMR showed subepicardial and mid-myocardial LGE in the basal, mid, and apical lateral segments accompanied by myocardial edema in mid and apical lateral segments on T2-weighted images. GLS by TTE and CMR was reduced (−14% and −12% respectively). The patient was diagnosed with acute myopericarditis and was treated with colchicine, ibuprofen, lisinopril, and metoprolol tartrate. He was discharged home in stable clinical condition and was asymptomatic when seen in outpatient cardiology clinic follow-up 4 weeks after discharge.”
Patient age: 20; Sex: Male
Medications at time of vaccination: None
“Patient rec’d Pfizer COVID vaccine dose 1 on 2/26/21; dose 2 on 3/18/21. He began to have substernal chest pain on 3/20/21, took Tums with partial relief. He had additional episodes of chest pain over the next 2 days and came to the ED on 3/22/21. EKG was abnormal and troponin was elevated, so he was admitted with a diagnosis of myopericarditis. EKG (3/21/21): NSR, HR 100, elevated ST in v4-6 TTE (3/22/21): (Left Ventricular Ejection Fraction) LVEF 51% Left ventricular systolic function is low normal (LVEF 51%). Normal diastolic function and filling pressures. – Normal right ventricular size and function. – Minimal mitral leaflet thickening with trace-mild MR. – Pulmonary pressure estimate is normal. – Aortic root, ascending aorta and arch are normal in caliber. – No previous echo available for comparison. Cardiac MRI w wo (3/22/21): 1. Low normal or mildly reduced global LV function with ejection fraction 53%. Normal RV function. 2. No evidence of myocardial infarction. Extensive subepicardial and mid wall enhancement throughout the LV free wall as described above. The appearance is consistent with myocarditis in the appropriate clinical context. 3. Partially visualized bulky left axillary adenopathy. This has been described in ipsilateral arm COVID-19 vaccination. Advise clinical correlation. PCRs: RPP incl SARS CoV-2 NP PCR (3/21/21): all neg Adenovirus PCR blood (3/21/21) : neg Parvovirus B19 PCR blood (3/21/21): neg Serologies: CMV IgM: < 2 HIV 1/2 Ag/Ab: neg Mycoplasma IgM: 1.19 (pos > 1.10) Lyme EIA Ab: .3 ASO: < 50 Coxsackie A Ab, 6 serotypes: all < 1:8 Coxsackie B Ab, 6 serotypes: all < 1:8 Echovirus Ab, 5 serotypes: all < 1:8 SARS CoV-2 IgG (3/22/21): neg (detects Ab to nucleocapsid, would be positive if wild type infection occurred) SARS CoV-2 Total Ab (3/22/21): positive (detects Ab to receptor binding domain on spike protein, is positive post-vaccination Urine tox screen (3/22/21): neg”