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Clinically suspected lethal viral myocarditis combined with encephalitis: a COVID-19 vaccine complication.

ABSTRACT: This case study aimed to identify rare viral myocarditis combined with encephalitis as a COVID-19 vaccine complication. A 59-year-old male patient with a 2 day history of headache and rapidly progressive cognitive decline, who had received the third dose of COVID-19 vaccine 12 days before, was admitted to our hospital. The patient had no underlying systemic conditions, no prior medical history, and no prior history of COVID-19 infection. The patient was diagnosed with viral myocarditis and encephalitis by two neurologists and two cardiologists after laboratory examination, head computed tomography, and magnetic resonance imaging evaluation. The patient experienced cardiogenic shock and developed severe arrhythmia, resulting in his death 10 h after admission. Clinically suspected lethal viral myocarditis combined with encephalitis in the patient could be related to COVID-19 vaccination. Adverse effects of the Chinese COVID-19 vaccine, especially serious complications, have been uncommon. This case study highlights a rare complication after COVID-19 vaccination that needs high attention.

SUBMITTER: Chen J

PROVIDER: S-EPMC9877651 | biostudies-literature | 2023 Apr

REPOSITORIES: biostudies-literature

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Clinically suspected lethal viral myocarditis combined with encephalitis: a COVID-19 vaccine complication.

Chen Junhui J Wu Ting T Zhang Chunlei C Zhang Ye Y Liu Zhuanghua Z Wang Yuhai Y

ESC heart failure 20221108 2

This case study aimed to identify rare viral myocarditis combined with encephalitis as a COVID-19 vaccine complication. A 59-year-old male patient with a 2 day history of headache and rapidly progressive cognitive decline, who had received the third dose of COVID-19 vaccine 12 days before, was admitted to our hospital. The patient had no underlying systemic conditions, no prior medical history, and no prior history of COVID-19 infection. The patient was diagnosed with viral myocarditis and encep ...[more]

PMID: 36347824

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Project description:AimsMyocardial inflammation is increasingly detected noninvasively by tissue mapping with cardiovascular magnetic resonance (CMR). Intraindividual agreement with endomyocardial biopsy (EMB) or markers of myocardial injury, high-sensitive cardiac troponin (hs-cTnT) in patients with clinically suspected viral myocarditis is incompletely understood.MethodsProspective multicenter study of consecutive patients with clinically suspected myocarditis who underwent blood testing for hs-cTnT, CMR, and EMB as a part of diagnostic workup. EMB was considered positive based on immunohistological criteria in line with the European Society of Cardiology (ESC) definitions. CMR diagnoses employed tissue mapping using sequence-specific cut-off for native T1 and T2 mapping; active inflammation was defined as T1 ≥2 standard deviation (SD) and T2 ≥2 SD above the mean of normal range. Hs-cTnT of greater than 13.9 ng/L was considered significant.ResultsA total of 114 patients (age (mean ± SD) 54 ± 16, 65% males) were included, of which 79 (69%) had positive EMB criteria, 64 (56%) CMR criteria, and a total of 58 (51%) positive troponin. Agreement between EMB and CMR diagnostic criteria was poor (CMR vs ESC: area under the curve (AUC): 0.51 (0.39-0.62)). The agreement between a significant hs-cTnT rise and CMR-based diagnosis of myocarditis was good (AUC: 0.84 (0.68-0.92); p < 0.001), but poor for EMB (0.50 (0.40-0.61). Hs-cTnT was significantly associated with native T1 and T2, high-sensitive C-reactive protein, and N-terminal pro-hormone brain natriuretic peptide (r = 0.37, r = 0.35, r = 0.30, r = 0.25; p < 0.001), but not immunohistochemical criteria or viral presence.ConclusionIn clinically suspected viral myocarditis, all diagnostic approaches reflect the pathophysiological elements of myocardial inflammation; however, the differing underlying drivers only partially overlap. The EMB and CMR diagnostic algorithms are neither interchangeable in terms of interpretation of myocardial inflammation nor in their relationship with myocardial injury.

Dataset Information

Clinically suspected lethal viral myocarditis combined with encephalitis: a COVID-19 vaccine complication.

Publications

Clinically suspected lethal viral myocarditis combined with encephalitis: a COVID-19 vaccine complication.

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