Fulminant Myocarditis 24 Days after Coronavirus Disease Messenger Ribonucleic Acid Vaccination

Figures

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  Figure 1.. A: Electrocardiography performed on admission showing abnormal Q waves in leads II, III, aVF, and V1 to 3. Transthoracic echocardiography showing left ventricular hypokinesis with mild pericardial effusion (B, end-diastolic phase of parasternal long-axis view; C, end-systolic phase of the parasternal long-axis view).

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  Figure 2.. Endomyocardial biopsy specimen showing myocyte damage, increased interstitial fibrosis, and cell infiltration (A, Hematoxylin and Eosin staining) with more CD3+ cells [B (both CD4+ cells (C) and CD8+ cells (D))] and more CD68+ cells (E) and less CD20+ cells (F) (×200).

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  Figure 3.. Time course of electrocardiography and serum creatinine kinase.

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  Figure 4.. Eosinophils are seen in the myocardium biopsy sample (Hematoxylin and Eosin staining, ×400).

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  Figure 5.. Immunostaining of the myocardium biopsy sample using antibodies for ACE2, SARS-CoV-2 (COVID-19) spike protein, and C4d. In the myocardium biopsy sample with myocarditis (A, Hematoxylin and Eosin staining, ×200), ACE2 (B, ×200) and SARS-CoV-2 (COVID-19) spike protein (C, ×200) were positive in some myocytes, while C4d (D) was positive in some myocytes and interstitial cells. SARS-CoV-2: severe acute respiratory syndrome coronavirus 2, COVID-19: coronavirus disease 2019, ACE2: angiotensin-converting enzyme 2