Fulminant Necrotizing Eosinophilic Myocarditis After COVID-19 Vaccination Survived with Mechanical Circulatory Support

Figures

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  Figure 1. Electrocardiographic and chest X‐ray images at admission and after the treatment with mechanical circulatory support and corticosteroid. Electrocardiography showed widening of QRS duration and ST‐segment elevation in leads II, III, aVF, and V1 through V4 at admission (A). These findings were almost normalized except first‐degree atrioventricular block after the treatment (B). Chest X‐ray at admission demonstrated enlargement of cardiac silhouette and pulmonary congestion (C). Cardiac silhouette enlargement and pulmonary congestion were improved after the treatment (D).

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  Figure 2. Echocardiographic images at admission and 1 month after the onset of fulminant myocarditis. Parasternal long‐axis views of transthoracic echocardiography at diastole (A) and systole (B) at admission. Left ventricular (LV) systolic function was severely impaired, but dilatation of the LV dimension was not observed. Pericardial effusion was noticeable (arrowheads). Parasternal long‐axis views at diastole (C) and systole (D) after the weaning from mechanical circulatory support and inotropes demonstrated the shortening of LVIDs suggesting recovery of systolic function.

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  Figure 3. Histopathological findings of endomyocardial biopsy specimens stained with haematoxylin–eosin at admission and 1 month after the onset of fulminant myocarditis. Low power magnification (×100) showed diffuse infiltration of mononuclear cells in the entire myocardial tissue at the initial biopsy (A). Marked infiltration of eosinophils (arrowheads) with severe tissue injury and cardiomyocyte necrosis (asterisks) were noticeable at high power magnification (×400) (B), and degranulation of eosinophils was also observed (arrows) (C). There was no apparent infiltration of inflammatory cells in the myocardium and tissue injury was repaired at the repeat biopsy after treatment with mechanical circulatory support and immunosuppression therapy; low (×100) (D) and high power magnification (×400) (E) are shown.