Temporal Association Between the COVID-19 Ad26.COV2.S Vaccine and Acute Myocarditis: A Case Report and Literature Review

Coronavirus disease‐19 (COVID‐19) vaccines are massively administered globally and some adverse events, such as myocarditis, are being reported. Most of the reported cases of post‐vaccination myocarditis have occurred following mRNA vaccinations. However, there have also been recent reports of myocarditis following adenovirus vector vaccinations. We present a case of a 32‐year‐old female patient who developed myocarditis following the administration of the first dose of the AstraZeneca vaccine. The patient developed inappropriate exertional tachycardia and exertional dyspnea from Day 3 and was diagnosed with myocarditis by subsequent echocardiography about 3 months later. We are unable to confirm a direct association between myocarditis and AstraZeneca vaccination. However, we would like to increase awareness regarding the possibility of developing myocarditis following AstraZeneca vaccination.

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“…However, there have been recent reports of myocarditis following adenovirus vector COVID‐19 vaccines as well. 5 , 6 , 7 , 8 , 9 , 10 …”

Section: Discussionmentioning

confidence: 99%

“…This patient received symptomatic treatments which lead to his discharge following clinical improvement. 5 , 8 …”

Section: Discussionmentioning

confidence: 99%

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Myocarditis following AstraZeneca (an adenovirus vector vaccine) COVID‐19 vaccination: A case report

Hassanzadeh¹,

Sadeghi

Mirdamadi

et al. 2022

Clinical Case Reports

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“…A number of studies have demonstrated post-COVID-19 vaccine-related myositis [12][13][14]. There was also cardiovascular involvement including myocarditis and myopericarditis [15][16].…”

Section: Discussionmentioning

confidence: 99%

COVID-19 Vaccine-Induced Pneumonitis, Myositis and Myopericarditis

Farooq¹,

Mohammed²,

Zafar³

et al. 2022

Cureus

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A 63-year-old male, with no significant past history and not on any regular medications previously, had mild respiratory symptoms post the first dose of the AstraZeneca (Cambridge, England) coronavirus disease 2019 (COVID-19) vaccine, which were self-limiting. Following the second dose of the vaccine, he arrived at the emergency department (ED) with worsening shortness of breath.During this admission, he was assumed to have interstitial lung disease due to a possible past history of occupational exposure. He responded to a short-term course of corticosteroids and antibiotics and was discharged home.However, he reported again to the emergency department three weeks later, with persistent dyspnoea along with myalgia. His blood tests and imaging from scans suggested myositis, pneumonitis, and myopericarditis. Since he recently had the COVID-19 AstraZeneca vaccine, it was postulated as the most likely cause of the symptoms. He was managed with intravenous (IV) corticosteroids followed by oral corticosteroids with symptom resolution.

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“…In this case, relatively similar rates of myocarditis occurrence would be expected among receivers of adenoviral vector-based platforms. the currently available evidence presents a rather solid counterargument against this scenario; while cases of myocarditis/pericarditis in association with administration of the ChAdOx1 vaccine (Vaxzevria, AstraZeneca) have also been reported, they do not seem to occur more frequently than expected in the absence of vaccination [ 23 , 24 ], while there is so far one published only 1 case reported after Janssen Ad26.COV2.S [ 25 ]. Furthermore, mRNA strands are immunogenic and may themselves trigger an immune response directed against cardiomyocyte epitopes or adversely influence the myocardium in the frame of an exaggerated systemic reaction [ 22 ].…”

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confidence: 99%

Potential implications of lipid nanoparticles in the pathogenesis of myocarditis associated with the use of mRNA vaccines against SARS-CoV-2

et al. 2022

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Although mRNA-based vaccines BNT162b2 and mRNA-1273 exhibit a remarkable efficacy and effectiveness in preventing particularly severe Covid-19 with an overall favorable adverse event profile, their use has been associated with rare cases of acute myocarditis. These occur most commonly after the second dose, with the highest incidence among young male recipients. This complication has not been observed among adenoviral vector vaccine receivers, and its clinical, laboratory and imaging features resemble those of other common causes of acute myocarditis. The pathogenesis of mRNA-vaccine associated myocarditis has not yet been elucidated, although a number of mechanisms have been proposed, typically implicating the administered S-protein mRNA and likely mediated through an autoimmune mechanism. Nonetheless, other mechanisms may be implicated given the fact that myocarditis cases are very rarely observed among recipients of non mRNA vaccines. The recent observation of a similar adverse event in a recipient of the non-mRNA, peptide-based NVX-CoV2373 in the frame of a phase III clinical trial with 7020 participants in the active treatment arm raises the question whether the lipid nanoparticle sheath, which is a common structural component of these platforms could be implicated in the pathogenesis of vaccine-induced myocarditis.

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Temporal Association Between the COVID-19 Ad26.COV2.S Vaccine and Acute Myocarditis: A Case Report and Literature Review

Cited by 43 publications

References 36 publications

Myocarditis following AstraZeneca (an adenovirus vector vaccine) COVID‐19 vaccination: A case report

Myocarditis following AstraZeneca (an adenovirus vector vaccine) COVID‐19 vaccination: A case report

COVID-19 Vaccine-Induced Pneumonitis, Myositis and Myopericarditis

Potential implications of lipid nanoparticles in the pathogenesis of myocarditis associated with the use of mRNA vaccines against SARS-CoV-2

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