Fulminant Myocarditis and Acute Appendicitis after COVID-19 Vaccination

Figures

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  Figure 1.. Abdominal computed tomography revealed a swollen appendix (A: transverse view, B: coronal view)

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  Figure 2.. Chest radiography showed normal findings with a cardiothoracic ratio of 49.7% (A). Electrocardiography revealed sinus tachycardia, abnormal Q waves in leads V1-3, and slight ST-segment elevation in leads I, II, aVF, and V2-6 (B). Transthoracic echocardiography showing left ventricular hypokinesis with mild pericardial effusion (C: end-diastolic phase of parasternal long-axis view, D: end-systolic phase of the parasternal long-axis view).

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  Figure 3.. Cell infiltration in the myocardium (A, Hematoxylin and Eosin staining) with CD3+ cells (B), both CD4+ cells (C), CD8+ cells (D), more CD68+ cells (E), and fewer CD20+ cells (F) (×200).

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  Figure 4.. 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), SARS-CoV-2 (COVID-19) spike protein (C, ×200), and C4d (D) were negative in myocytes. SARS-CoV-2: severe acute respiratory syndrome coronavirus 2, COVID-19: coronavirus disease 2019, ACE2: angiotensin-converting enzyme 2

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  Figure 5.. Time course of electrocardiography, echocardiographic data, and laboratory data. CRP: C-reactive protein, CK: creatinine kinase, NT-proBNP: N-terminal pro-brain natriuretic peptide, LVEF: left ventricular ejection fraction, IVST: interventricular septal thickness, LVPW: left ventricular posterior wall thickness