Acute Perimyocarditis in an Adolescent Japanese Male after a Booster Dose of the BNT162b2 COVID-19 Vaccine

Abstract

Perimyocarditis is a rare and serious cardiac complication following COVID-19 vaccination.Young males are most at risk after the second dose. With the introduction of the booster (third) dose, some reports have focused on the risk of perimyocarditis after a booster dose. However, no currently available report in Japan has comprehensively described this phenomenon. A healthy 14-year-old Japanese male, who had completed a two-dose primary series of the BNT162b2 (Pfizer-BioNTech) vaccine six months prior, developed fever and chest pain within 24 hours after a homologous booster dose. He was transferred to our institute because of worsening chest pain. A multiplex PCR test showed no evidence of active viral infections, including SARS-CoV-2. Electrocardiography revealed ST-segment elevation in almost all leads, suggesting pericarditis. Echocardiography showed normal systolic function. Laboratory data demonstrated C-reactive protein levels of 8.8 mg/dL and elevated cardiac damage markers (troponin T: 1.9 ng/mL, creatine phosphokinase:1527 U/L, MB isoenzyme: 120 U/L), suggesting myocarditis. He was diagnosed with perimyocarditis associated with the booster dose, which was confirmed by cardiac magnetic resonance imaging four days after initial symptoms. Chest pain improved spontaneously along with a resolution of electrocardiographic findings and laboratory data within several days. He was discharged eight days after admission.Perimyocarditis is less frequent after a booster dose than after primary doses. In this case, the patient with booster-dose-associated perimyocarditis showed favorable clinical course without severe sequelae. The patient's clinical course was consistent with findings on previous largescale reports on primary-dose-associated perimyocarditis and case series on booster-doseassociated perimyocarditis.

COVID-19 vaccine-associated myocarditis in an adolescent after the third vaccine dose. Case report with follow-up

“…Over the last few months, there have been isolated reports of C-VAM after the third dose of COVID-19 vaccination in the adult population (4) . To our best knowledge, up to now, only two full descriptions of the course of COVID-19 third-dose-related isolated C-VAM and one case report of myocarditis with concomitant pericarditis have been published among the paediatric population (5,6) . We present the first case study of an adolescent with C-VAM developing after the third vaccine dose.…”