Intramyocardial Inflammation after COVID-19 Vaccination: An Endomyocardial Biopsy-Proven Case Series

Figures

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  Figure 1. Representative images of haematoxylin and eosin (H & E) staining, and immunohistochemical stainings for the assessment of inflammation in endomyocardial biopsies from patients with the suspicion of myocarditis after COVID-19 vaccination. Immunohistochemical detection of CD3+ T cells, CD45R0+ T-memory cells, LFA-1+ lymphocytes, MAC-1+ macrophages, perforin+ cytotoxic cells and HLA-DR+ activated T cells in patients diagnosed for (A) inflammatory cardiomyopathy (DCMi, patient 4, Comirnaty® vaccine), (B) acute myocarditis (AMC, patient 2, Comirnaty® vaccine) and (C,D) giant cell myocarditis (GCMC, patient 14, Janssen® vaccine; patient 3, Cormirnaty® vaccine; giant cells are marked by arrows in H & E staining). Immunohistochemical staining was quantified by digital image analysis and is depicted for each patient in Table 2. Magnification 200×. Scale bars 50 μm.

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  Figure 2. Evidence of SARS-CoV-2 spike protein in cardiac tissue after COVID-19 vaccination. (A–C) Representative immunohistochemical stainings of SARS-CoV-2 spike protein in EMBs from patients diagnosed with DCMi after receiving Comirnaty® (panel A and B, patients 5 and 10) or Vaxzevria® (panel C, patient 13). (D) SARS-CoV-2-positive cardiac tissue served as positive control. Magnification 400×. Scale bars 20 μm.

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  Figure 3. Inflammatory cardiomyopathy in response to COVID-19 vaccination is dominated by CD4+ T cells. (A–C) Representative immunohistochemical stainings of CD4+ and CD8+ T cells in endomyocardial biopsies from patients diagnosed for inflammatory cardiomyopathy (DCMi) after receiving Comirnaty® (panel A and B, patients 6 and 10) or Vaxzevria® (panel C, patient 13) vaccines, respectively. Immunohistochemical staining was quantified by digital image analysis and CD4-to-CD8 ratio is depicted for each patient in Table 2. Magnification 400×. Scale bars 20 μm.