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Myocarditis and pericarditis following mRNA vaccination in autoimmune inflammatory rheumatic disease patients: A

Shreeya Patel1, Emma Wu1, Maninder Mundae1

  • 1Department of Rheumatology Western Hospital Footscray Victoria Australia.

Rheumatology & Autoimmunity
|August 9, 2022
PubMed
Abstract

Insights

mRNA vaccines, while effective against COVID-19, carry a small risk of myocarditis and pericarditis. This risk may be elevated in patients with autoimmune inflammatory rheumatic diseases (AIRD), as suggested by three case studies.

Area of Science:

  • Cardiology
  • Rheumatology
  • Immunology

Background:

  • Messenger RNA (mRNA) vaccines (Pfizer/BioNTech, Moderna) are highly effective against SARS-CoV-2.
  • These vaccines are associated with a rare increased risk of myocarditis and pericarditis.
  • Patients with autoimmune inflammatory rheumatic diseases (AIRD) may face a heightened risk of these cardiac complications.

Purpose of the Study:

  • To report on three cases of myocarditis or pericarditis in patients with pre-existing AIRD following their first dose of the Pfizer-BioNTech mRNA vaccine.
  • To discuss the potential association between mRNA vaccines and cardiac events in AIRD patients.
  • To review current clinical considerations and research regarding this risk.

Main Methods:

  • Case series describing three patients with AIRD (Systemic Lupus Erythematosus, Anti-phospholipid Syndrome, Inflammatory Arthritis, Behcet's disease) who developed cardiac symptoms post-vaccination.
  • Clinical assessment included troponin levels, transthoracic echocardiogram (TTE), and electrocardiogram (ECG).
  • Treatment involved prednisolone, with subsequent symptom resolution.

Main Results:

  • Three patients with AIRD developed myocarditis or pericarditis within 7 days of their first Pfizer-BioNTech vaccine dose.
  • Clinical presentations varied, including myopericarditis with elevated troponin and TTE abnormalities, and ECG changes suggestive of pericarditis.
  • All patients responded well to prednisolone treatment, experiencing rapid recovery.

Conclusions:

  • The cases suggest a possible association between mRNA COVID-19 vaccination and the development of myocarditis/pericarditis in patients with AIRD.
  • Further research is warranted to understand the specific risks and underlying mechanisms in this patient population.
  • Clinical vigilance and individualized risk assessment are important when considering mRNA vaccination for AIRD patients.
Keywords:
mRNA vaccinesmyocarditispericarditissevere acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2)

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