Abstract
A 22-year-old man without any medical history developed fever three days after receiving the first dose of the Moderna vaccine (mRNA-1273; Moderna, Inc., Massachusetts, United States), but his symptom was naturally improved. On the 12th day after the second vaccination, he developed fever, headache, and redness in both eyes. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction test result was negative, but his symptoms were gradually worsening. Blood examinations on admission (the 24th day after the second vaccination, Day1) showed an increasing of C-reactive protein and D-dimer. In addition, contrast-enhanced computed tomography (CT) revealed hepatosplenomegaly and a contrast-enhanced defective area in the kidney. Subsequently, his fever subsided, and he was discharged on Day23, but he was readmitted for chest pain on Day26. We diagnosed non-ST elevation myocardial infarction (MI), and coronary angiography (CAG) revealed total occlusion of the atrioventricular branch of the right coronary artery (RCA), and 90% stenotic lesions with >3 mm coronary ectasia in the left circumflex artery (LCx). The optical coherence tomography (OCT) findings showed blurring of vessel construction, intimal thickening, medial destruction, and thrombus in the RCA and LCx lesions. Based on the Brighton Collaboration Network definition, we diagnosed the condition as multisystem inflammatory syndrome (MIS) after SARS-CoV-2 vaccination (MIS-V), presenting with systemic vasculitis lesions. Following antithrombotic therapy with warfarin, aspirin, and prednisolone (60mg/day), his D-dimer levels and inflammatory response promptly improved. Furthermore, coronary artery irregularities, especially in the LCx lesion, showed improvement on CAG on Day43. Follow-up OCT showed resolution of the thrombus and healing of the medial destruction. The prednisolone dose was reduced, and the patient was discharged. Follow-up CAG and OCT after six months showed further improvements of initial findings. So, we decided to stop warfarin and prednisolone according to these results. His clinical course is very good without symptoms after that. This is the first report of MI due to MIS-V with longitudinal OCT findings.
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