Acute myocarditis after SARS-CoV-2 vaccination in a 24-year-old man

A 24-year old male nurse presented to the emergency department complaining of chest pain with onset 24 hours earlier.He reported no past medical history and no cardiovascular risk factors apart from e-cigarette smoking.He received the second dose of COVID-19 mRNA BNT162b2 vaccine 60 hours before the onset of chest pain exacerbated by deep breathing and being in a supine position.The chest pain was exacerbated by deep breathing and the supine position.It radiated to the back and the left arm and was responsive to non-steroidal anti-inflammatory drugs.The electrocardiogram (ECG) showed sinus tachycardia, mild ST-elevation in inferior leads, and mild ST-depression in leads V1 to V3 (Figure 1A).The echocardiogram showed mildly reduced left ventricle ejection fraction (EF 45%) with inferior-posterior wall hypokinesia and hyperechogenicity of the pericardium without effusion.With a diagnosis of suspected acute coronary syndrome (ACS), the patient was referred to the hub hospital for urgent coronary angiography, which showed a normal coronary tree.Laboratory analyses revealed elevated cardiac-specific markers (high-sensitive cardiac troponin T 1204 ng/L, creatine kinase-MB 79 UI/L; normal <14 and <25, respectively), high C-reactive protein (1.9 mg/dl; normal <0.5) and normal blood count (white blood cells 9300/mm 3 , neutrophil-lymphocyte ratio 3.8).SARS-CoV-2 swab was negative, while antibodies against SARS-CoV2-2 were present (IgM 3.8, IgG 56.1; negative <1).