Autoimmune Rheumatic Disease Flares with Myocarditis Following COVID-19 mRNA Vaccination: A Case-Based Review

Abstract

Since the introduction of coronavirus disease 2019 (COVID-19) messenger ribonucleic acid (mRNA) vaccines, there have been multiple reports of post-vaccination myocarditis (mainly affecting young healthy males). We report on four patients with active autoimmune rheumatic diseases (ARDs) and probable or confirmed myocarditis following COVID-19 mRNA vaccination managed at a tertiary hospital in Singapore; we reviewed the literature on post-COVID-19 mRNA vaccination-related myocarditis and ARD flares. Three patients had existing ARD flares (two had systemic lupus erythematosus (SLE), one had eosinophilic granulomatosis polyangiitis (EGPA)), and one had new-onset EGPA. All patients recovered well after receiving immunosuppressants comprising high-dose glucocorticoids, cyclophosphamide, and rituximab. Thus far, only one case of active SLE with myocarditis has been reported post-COVID-19 mRNA vaccination in the literature. In contrast to isolated post-COVID-19 mRNA vaccination myocarditis, our older-aged patients had myocarditis associated with ARD flares post-COVID-19 vaccination (that occurred after one dose of an mRNA vaccine), associated with other features of ARD flares, and required increased immunosuppression to achieve myocarditis resolution. This case series serves to highlight the differences in clinical and therapeutic aspects in ARD patients, heighten the vigilance of rheumatologists for this development, and encourage the adoption of risk reduction strategies in this vulnerable population.

Eosinophilic Granulomatosis with Polyangiitis after mRNA-1273 SARS-CoV-2 Vaccine

“…We report here a severe case of Eosinophilic Granulomatosis with Polyangiitis (EGPA), occurring in temporal relationship with SARS-CoV-2 vaccination and complicated by immune thrombocytopenia (ITP). This adds to the few reports of flares and new-onset EGPA after mRNA vaccines reviewed below [ 5 , 6 , 7 , 8 , 9 ].…”

Rheuma nach COVID-19-Infektion oder Impfung

“…Nach COVID-19-Impfung kann es zu ähnlichen rheumatischen Krankheitsbildern kommen wie nach COVID-Infektion [40][41][42][43][44]. Beschrieben wurden nach SARS-CoV-2 Impfung unter anderem der Beginn einer diffus kutanen Sklerose, ANCA-assoziierte Vaskulitis [45], RS3PE("remitting seronegative symmetrical synovitis with pitting edema")-Syndrom [46], Still-Syndrom des Erwachsenen (AOSD) [47] und entzündliche Muskelerkrankungen wie Polymyalgia rheumatica (PMR) oder PMRähnlichen Symptomen [48], Myositis [49] und Myokarditis [50].…”