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Erroneous diagnosis of COVID-19 mRNA vaccine-associated acute myocarditis due to false-positive high-sensitive troponin I assay: a case report.

ABSTRACT:

Background

Coronavirus disease 2019 (COVID-19) mRNA vaccine-associated acute myocarditis has been well described, and the demonstration of elevated high-sensitivity cardiac troponin (hs-cTn) is crucial for its diagnosis. However, falsely elevated hs-cTn can occasionally occur, leading to incorrect diagnosis. Here, we report the case of a patient who was given an erroneous diagnosis of COVID-19 mRNA vaccine-associated acute myocarditis due to falsely elevated hs-cTn, likely from assay interference.

Case summary

A 29-year-old Chinese male presented with 3 months of chest pain, dyspnoea, and palpitations starting a few days after his second dose of mRNA-1273 (Moderna) vaccine. High-sensitivity cardiac troponin I was elevated at presentation, which rose further 4 h later. The provisional diagnosis was acute myocarditis after a computed tomography coronary angiogram showed normal coronaries. Cardiac magnetic resonance was also negative for myocardial inflammation. The hs-cTn I levels fluctuated but remained elevated on outpatient serial testing, despite no new symptoms or clinical events. A paired serum sample showed elevated hs-cTn I but normal hs-cTn T, confirming a diagnosis of false-positive hs-cTn I. Further investigations, including blood tests before and after a subsequent uneventful mRNA-1273 booster vaccination, were performed to investigate for assay interference.

Discussion

Widespread COVID-19 mRNA vaccination has resulted in an awareness of vaccine-related acute myocarditis and a more thorough evaluation of post-vaccination cardiac symptoms. Although false-positive hs-cTn rarely occurs, extensive testing will inevitably result in a significant number of patients with falsely elevated hs-cTn. Clinicians should exclude this possibility and consider using alternative hs-cTn assay when investigation results and clinical presentation appear discordant.

SUBMITTER: Suan VGY

PROVIDER: S-EPMC9746682 | biostudies-literature | 2022 Dec

REPOSITORIES: biostudies-literature

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Publications

Erroneous diagnosis of COVID-19 mRNA vaccine-associated acute myocarditis due to false-positive high-sensitive troponin I assay: a case report.

Suan Vivian Goh Yi VGY Hawkins Robert R Yew Min Sen MS

European heart journal. Case reports 20221122 12

<h4>Background</h4>Coronavirus disease 2019 (COVID-19) mRNA vaccine-associated acute myocarditis has been well described, and the demonstration of elevated high-sensitivity cardiac troponin (hs-cTn) is crucial for its diagnosis. However, falsely elevated hs-cTn can occasionally occur, leading to incorrect diagnosis. Here, we report the case of a patient who was given an erroneous diagnosis of COVID-19 mRNA vaccine-associated acute myocarditis due to falsely elevated hs-cTn, likely from assay int ...[more]

PMID: 36524204

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Project description:BackgroundIn most patients with stable coronary artery disease, plasma cardiac troponin T levels are below the limit of detection for the conventional assay. The distribution and determinants of very low circulating troponin T levels, as well as their association with cardiovascular events, in such patients are unknown.MethodsWe used a new, high-sensitivity assay to determine the concentration of cardiac troponin T in plasma samples from 3679 patients with stable coronary artery disease and preserved left ventricular function. Results of the assay were analyzed in relation to the incidence of cardiovascular events during a median follow-up period of 5.2 years.ResultsWith the highly sensitive assay, concentrations of cardiac troponin T were at or above the limit of detection (0.001 microg per liter) in 3593 patients (97.7%) and at or above the 99th percentile for apparently healthy subjects (0.0133 microg per liter) in 407 patients (11.1%). After adjustment for other independent prognostic indicators, there was a strong and graded increase in the cumulative incidence of cardiovascular death (adjusted hazard ratio per unit increase in the natural logarithm of the troponin T level, 2.09; 95% confidence interval [CI], 1.60 to 2.74; P<0.001) and of heart failure (adjusted hazard ratio, 2.20; 95% CI, 1.66 to 2.90; P<0.001) in this study group. Increased risk associated with higher levels of troponin T was evident well below the limit of detection of conventional cardiac troponin T assays and below the 99th percentile of values in a healthy population. There was no association between troponin T levels as measured with the highly sensitive assay and the incidence of myocardial infarction (adjusted hazard ratio, 1.16; 95% CI, 0.97 to 1.40; P=0.11).ConclusionsAfter adjustment for other independent prognostic indicators, cardiac troponin T concentrations as measured with a highly sensitive assay were significantly associated with the incidence of cardiovascular death and heart failure but not with myocardial infarction in patients with stable coronary artery disease.

Dataset Information

Erroneous diagnosis of COVID-19 mRNA vaccine-associated acute myocarditis due to false-positive high-sensitive troponin I assay: a case report.

Background

Case summary

Discussion

Publications

Erroneous diagnosis of COVID-19 mRNA vaccine-associated acute myocarditis due to false-positive high-sensitive troponin I assay: a case report.

Similar Datasets

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