Acute Pericarditis Post mRNA-1273 COVID Vaccine Booster

Abstract

Cardiovascular complications such as arrhythmias, hypoxemic cardiomyopathy, pericarditis, myocardial infarction, heart failure, and myocarditis are rare but seen in COVID-19 patients. These cardiac injuries could be the result of direct SARS-CoV-2 effects. The most prominent mediator of this hypothesis is angiotensin-converting enzyme-2 (ACE2) receptors, which are highly expressed in heart and lung tissues. These ACE2 receptors are found to be the functional receptors for the Coronavirus. Another hypothesis for cardiac complications in COVID-19 patients is macrophage-induced inflammation. The SARS-CoV-2 infection leads to invasion of epithelial cells by binding with ACE-2 receptors, localized inflammation, endothelial and macrophage activation, tissue damage, and dysregulated cytokine release. Current data have shown that mRNA COVID-19 vaccines are efficacious and safe for indicated patients. However, these vaccines can cause mild adverse reactions similar to those of traditional vaccines, and more severe side effects can also be seen infrequently. The exact pathogenesis of COVID-19 vaccine-induced pericarditis remains unknown, but there are several hypotheses regarding the pathophysiology of pericarditis after COVID-19 vaccine administrations. There has been speculation that mRNA vaccines can produce a large number of antibodies in a small subgroup of people, especially young individuals, and this elicits an inflammatory response similar to the multisystem inflammatory syndrome associated with SARS-CoV-2 infection. Another proposed mechanism is the cross-reaction between produced antibodies and the pericardium, leading to myocardial and pericardial inflammation induction. This report describes a 69-year-old female who presented with three days of chest pain that started one day after a booster shot of the Moderna COVID-19 vaccine. The patient was diagnosed with pericarditis, and she was effectively treated with colchicine and later steroids.

An autopsy case report of aortic dissection complicated with histiolymphocytic pericarditis and aortic inflammation after mRNA COVID-19 vaccination

“…SARS-CoV-2 vaccines have been associated with rare, but sometimes fatal, cardiovascular side effects such as thromboembolism, myocarditis/pericarditis, arrhythmia, and cardiomyopathy [4] , [5] , [6] , [7] , [8] , [9] . Fazlollahi et al [6] summarized the features of seven pericarditis cases after vaccination from case reports and case series.…”

Variation of total anti-SARS-CoV-2 antibodies after primary BNT162b2 vaccination and homologous booster

“…Among the potentially more vulnerable subjects, those with blunted immunogenic response and sharper and/or faster decay of anti-SARS-CoV-2 neutralizing antibodies were found to have magnified risk of breakthrough infections and unfavorable progression of COVID-19, including increased rates of hospital admission, need of mechanical ventilation or intensive care, and a greater risk of death [9,10]. Personalized vaccine administration would also be effective to concomitantly avert the risk of rare side effects in those who could safely delay primary cycle or boosters [11].…”