Myocarditis, Pulmonary Hemorrhage, and Extensive Myositis with Rhabdomyolysis 12 Days After First Dose of Pfizer-BioNTech BNT162b2 mRNA COVID-19 Vaccine: A Case Report

Abstract

Patient: Male, 37-year-old Final Diagnosis: Immune-mediated myocarditis • pulmonary vasculitis • myositis • thrombocytopenia Symptoms: Episode of hemoptysis with blood less than 100 ml • one-day history of sudden onset severe shortness of breath associated with orthopnea, dry cough and excessive sweating • reducing sensation to fine touch and temperature at the entire left upper limb • three-days history of back pain Medication: — Clinical Procedure: — Specialty: General and Internal Medicine Objective: Unusual clinical course Background: The COVID-19 pandemic is a current global crisis, and there are hundreds of millions of individuals being vaccinated worldwide. At present, there have been few reports of COVID-19 vaccine-induced autoimmune processes manifested as myositis, thrombocytopenia, and myocarditis. Case Report: A 37-year-old man presented to the Emergency Department (ED) with a 3-day history of back pain and a 1-day history of left upper limb swelling with paresthesia and shortness of breath, 12-days after receiving the first dose of Pfizer/BioNTech BNT162b2 mRNA COVID-19 vaccine. He was diagnosed with severe myositis complicated with rhabdomyolysis and non-oliguric acute kidney injury, thrombocytopenia, myocarditis with pulmonary edema, and pulmonary hemorrhage. Screens for potential toxic, infectious, paraneoplastic, and autoimmune disorders were unremarkable. The patient was treated with a 5-day course of intravenous methylprednisolone and intravenous immunoglobulin, with a good response. He was hospitalized for 16 days and discharged home on a tapering dose of oral prednisolone for 6 weeks. Conclusions: The case describes a possible link between Pfizer/BioNTech BNT162b2 mRNA COVID-19 vaccine and immune-mediated myocarditis, pulmonary vasculitis, myositis, and thrombocytopenia. However, further data are required to confirm such an association.

A Possible Case of COVID-19 Booster Vaccine–Associated Rhabdomyolysis and Acute Kidney Injury

“…Given an unremarkable workup and the proximity of the Pfizer-BioNTech BNT162b2 mRNA COVID-19 vaccine administration, a generalized vaccine immune mediated process was suspected. 7 Following intravenous methylprednisolone, the patient improved dramatically and was weaned from oxygen on hospital day 7. 7 This association has not been reported solely with the Pfizer-BioNTech COVID-19 vaccine as there was a case of rhabdomyolysis described in New Jersey, United States, following administration of the Ad26.COV2.S COVID-19 vaccine.…”

“…7 Following intravenous methylprednisolone, the patient improved dramatically and was weaned from oxygen on hospital day 7. 7…”

“…7 Following intravenous methylprednisolone, the patient improved dramatically and was weaned from oxygen on hospital day 7. 7 This association has not been reported solely with the Pfizer-BioNTech COVID-19 vaccine as there was a case of rhabdomyolysis described in New Jersey, United States, following administration of the Ad26.COV2.S COVID-19 vaccine. 8 A 19-year-old male patient noted myalgia, muscle weakness, and darkened urine 2 days following his Ad26.…”

Recurring Weakness in Rhabdomyolysis Following Pfizer–BioNTech Coronavirus Disease 2019 mRNA Vaccination

“…Research has suggested that adjuvants in influenza vaccines might be associated with rhabdomyolysis [15]. Rhabdomyolysis following Pfizer-BioNTech COVID-19 mRNA vaccination has recently been reported [10][11][12][13]16]. In these cases, certain additives might have played a role in the development of rhabdomyolysis following COVID-19 mRNA vaccination.…”

“…Therefore, MRI is considered invaluable in the early diagnosis of rhabdomyolysis [21]. However, MRI for diagnosis of COVID-19 vaccine-induced rhabdomyolysis has only been performed in a few cases [16,22,23]. Moreover, rhabdomyolysis associated with COVID-19 vaccination has not been assessed by repeated MRI within a short time.…”