Fatal Myocarditis following COVID-19 mRNA Immunization: A Case Report and Differential Diagnosis Review
Pedro Manuel Barros de Sousa1, Elon Almeida Silva1, Marcos Adriano Garcia Campos2
1University Hospital of the Federal University of Maranhão, Barão de Itapari Street 227, São Luís 65020-070, MA, Brazil.
Insights
A child died from myocarditis and pericarditis after receiving the mRNA COVID-19 vaccine. Autopsy revealed inflammation, prompting consideration of the vaccine as a potential cause or contributing factor.
Area of Science:
- Pediatric Cardiology
- Vaccine Safety
- Immunology
Background:
- Childhood carditis is rare with diverse causes.
- Investigating potential adverse events following novel vaccinations is crucial.
Observation:
- A 7-year-old boy developed fever and arthritis post-mRNA COVID-19 vaccination.
- Rapid deterioration led to death, with autopsy revealing pericarditis and myocarditis.
Findings:
- Autopsy showed myocardial inflammation (T CD8+ lymphocytes, histiocytes) and pericardial fibrin deposits.
- High antistreptolysin O titers suggested rheumatic fever, but typical features were absent.
- Temporal association with mRNA COVID-19 vaccination (COVIDmRNAV) warrants consideration.
Implications:
- The case highlights potential cardiac complications following COVIDmRNAV.
- Exosomes and lipid nanoparticles in COVIDmRNAV may trigger cytokine storms and myocardial damage.
- Further research is needed to understand COVIDmRNAV's role in pediatric carditis pathogenesis.
Abstract:
Carditis in childhood is a rare disease with several etiologies. We report a case of infant death due to pericarditis and myocarditis after the mRNA vaccine against COVID-19 (COVIDmRNAV). A 7-year-old male child received the first dose of the COVIDmRNAV and presented with monoarthritis and a fever non-responsive to oral antibiotics. The laboratory investigation showed signs of infection (leukocytosis, high levels of c-reactive protein). His condition rapidly deteriorated, and the patient died. The autopsy identified pericardial fibrin deposits, hemorrhagic areas in the myocardium, and normal valves. A diffuse intermyocardial inflammatory infiltrate composed of T CD8+ lymphocytes and histiocytes was identified. An antistreptolysin O (ASO) dosage showed high titers. The presence of arthritis, elevated ASO, and carditis fulfills the criteria for rheumatic fever. However, valve disease and Aschoff's nodules, present in 90% of rheumatic carditis cases, were absent in this case. The temporal correlation with mRNA vaccination prompted its inclusion as one of the etiologies. In cases of myocardial damage related to COVID-19mRNAV, it appears to be related to the expression of exosomes and lipid nanoparticles, leading to a cytokine storm. The potential effects of the COVID-19mRNAV must be considered in the pathogenesis of this disease, whether as an etiology or a contributing factor to a previously initiated myocardial injury.
