Key result
Total pericardiectomy resolves COVID-19 vaccine-associated constrictive pericarditis at 3 months post-op.
Why the study?
COVID-19 infection and vaccines have been associated with rare cases of pericarditis, but constrictive pericarditis following vaccination is not well documented.
Case Report (n=1)
This case report highlights a rare instance of constrictive pericarditis occurring after COVID-19 vaccination, which was successfully treated with total pericardiectomy.
May support pericardiectomy in rare post-vaccination constrictive pericarditis; leaves open causality, incidence, and practice implications.
Background: COVID-19 infection and the COVID-19 vaccines have been associated with rare cases of pericarditis. We present a case of constrictive pericarditis (CP) following the vaccine. Case summary: A 19-year-old healthy male started having progressive abdominal pain, emesis, dyspnoea, and pleuritic chest pain 2 weeks after the second dose of Pfizer vaccine. Computed tomography angiography chest revealed bilateral pleural effusions and pericardial thickening with effusion. Cardiac catheterization showed ventricular interdependence. Cardiac magnetic resonance (CMR) showed septal bounce and left ventricular tethering suggestive of CP. A total pericardiectomy was performed with significant symptom improvement. Pathology showed chronic fibrosis without amyloid, iron deposits, or opportunistic infections. Patient had Epstein-Barr Virus (EBV) viraemia 825 IU/mL and histoplasmosis complement-fixation positive with negative serum and urine antigen. Hypercoagulable panel and infectious workup were otherwise negative. The patient had resolution of cardiac symptoms at 3 months of follow-up. Discussion: The patient developed progressive symptoms within 2 weeks of his second Pfizer vaccine. Echocardiogram and CMR had classic signs of CP, and pericardial pathology confirmed fibrotic pericardium. The patient had no prior surgery, thoracic radiation, or bacterial infection. Epstein-Barr Virus viraemia was thought to be reactionary, and histoplasmosis complement likely represented chronic exposure. The timing of symptoms and negative multidisciplinary workup raises the suspicion for COVID vaccine-induced CP. The COVID vaccines benefits far exceed the risks, but complications still can occur. Practitioners should have a high index of suspicion to allow prompt diagnosis of CP.
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Bain et al. (2023) conducted a case report in Constrictive pericarditis (n=1). Pfizer COVID-19 vaccine was evaluated. A 19-year-old male developed constrictive pericarditis 2 weeks after his second Pfizer COVID-19 vaccine dose, with symptoms resolving 3 months post-pericardiectomy.
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