Tozinameran

Abstract

Myocarditis: case reportA 16-year-old boy developed myocarditis following tozinameran vaccination. The boy, who had no significant medical history, received tozinameran [BNT162b2; Pfizer-BioNTech; route and dosage not stated] coronavirus-19 (COVID-19) vaccine. Ten days after receiving the dose 2 of the tozinameran, he developed odynophagia, dry cough and myalgia. Thereafter, he was consulted an outpatient physician, who started on symptomatic treatment with prednisone for 5 days and achieved a partial response. Two weeks later, he developed oppressive chest pain with nausea, vomiting and palpitations and consulted in the emergency department. On admission, he was sub-febrile, tachycardic and had high BP without other significant findings on physical examination. An elevation in ultrasensitive troponin I was observed. His respiratory virus panel test was found to be negative. Electrocardiogram was noted as unremarkable. In view of suspected myocarditis, he was admitted to the coronary unit for monitoring and further investigations.The boy was started on ketoprofen and oral colchicine with progressive improvement in his chest pain. On admission day 2, his ultrasensitive troponin I continued to rise and then decreased on day 4. He did not present electrocardiographic disorders during hospitalization. A transthoracic echocardiogram revealed left ventricular ejection fraction of 60%, right and left ventricular function without segmental wall motion abnormalities and valve disorders of the pericardium without effusion. Cardiac MRI demonstrated a slight increase in T1 times of the inferolateral and lower walls of the basal third of the left ventricle without alterations in myocardial perfusion in the sequence first step. A mild pericardial effusion and delayed sub-epicardial enhancement in the inferolateral and lower walls of the basal third of the left ventricle were noted. Based on presenting symptoms and investigational findings, a diagnosis of myocarditis secondary to the tozinameran vaccination was made. He was maintained with the initial symptomatic treatment. On admission day 5, he was discharged from the hospital with ketoprofen and colchicine treatments. One month after discharge at the outpatient check-up, he was in good clinical condition with complete resolution of symptoms.