COVID-19 mRNA vaccination can rarely be associated with fulminant myocarditis requiring mechanical circulatory support in middle-aged women, with biopsy suggesting involvement of cytotoxic T lymphocytes and macrophages.
Rare post-mRNA vaccine fulminant myocarditis may require MCS; leaves open questions on incidence, causality, and optimal management.
A 48-year-old woman suffered from cardiogenic shock with fulminant myocarditis following the second dose of COVID-19 vaccine (mRNA-1273). Venoarterial extracorporeal membrane oxygenation and Impella support were essential in achieving hemodynamic stability. Endomyocardial biopsy revealed lymphocytic infiltration with predominant immunostaining for CD8- and CD68-positive cells. The left ventricular ejection fraction improved significantly after treatment with mechanical circulatory support. Myocarditis following COVID-19 mRNA vaccination may also occur in middle-aged women; it may be fulminant and require mechanical circulatory support. Although our results suggest the involvement of cytotoxic T lymphocytes and macrophages, further investigation is needed before these can be established as pathogenetic mechanisms.
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Kazama et al. (2022) studied this question.
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