Abstract 12435: A Rare Case of Pericarditis Following Varicella-Zoster Vaccination

Abstract

Introduction: We emphasise the role of imaging as illustrated by the case of a 71-year-old male who presented with acute pericarditis one day after receiving a Varicella Zoster Virus (VZV) Vaccination. Although active VZV infection itself is recognised as an uncommon trigger for pericarditis, and myopericarditis following several live attenuated vaccines, its occurrence specifically following VZV vaccination is rare. Case Presentation: This gentleman was previously fit and well prior with no significant comorbidity or drug allergies. Clinically, we suspected VZV vaccine-induced pericarditis in this case due to the short temporal relationship between vaccination and symptom onset and absence of other known infectious and non-infectious causes of pericarditis. This was in addition to characteristic chest pain, fever, sweating, electrocardiogram (clear PR depression and subtle concave ST elevation) and imaging (echocardiography and Cardiac MRI) features. Imaging Results: Pulmonary embolism was excluded by CT pulmonary angiography, but this scan did reveal a large, global pericardial effusion. Prompt transthoracic echocardiogram categorised the pericardial effusion as small and did not show any signs of cardiac tamponade. Cardiac MRI imaging demonstrated a large pericardial effusion but did not show any overt myocardial oedema, inflammation or fibrosis, consistent with a low high-sensitivity troponin I. Interestingly, the MRI did not reveal any convincing pericardial oedema or fibrosis acutely, which might be expected in pericarditis. Transthoracic echocardiography was important in excluding features of tamponade and helped confirm the diagnosis of acute pericarditis by clearly demonstrating the pericardial effusion. A Cardiac MRI was essential in excluding co-existent myocarditis and infarction. Conclusions: Acute pericarditis should be considered in patients presenting with chest pain after receiving the VZV vaccination and patients should be made aware of this rare side effect prior to receiving their vaccination. The patient in this case study responded well to symptomatic treatment with analgesia and colchicine, suggesting that anti-viral therapy is not required for VZV related pericarditis.