Moderna Vaccine Induced Recurrent Myopericarditis

Abstract

COVID-19 mRNA vaccine-related myocarditis and myopericarditis is a rare complication, with the US Centers for disease Control and Prevention reporting 4.2 per million females aged 12-29 years, dropping to 1.0 per million over 30, and exceptionally rare is recurrent myopericarditis requiring immunosuppressive therapy. We report a case of a 51-year-old female with no significant medical history presented to the emergency department with pleuritic chest pain, and progressive breathlessness 9 days after her first Moderna vaccine. Electrocardiography revealed widespread ST segment elevation with PR depression in the inferior leads. Her inflammatory markers were elevated with a C- reactive protein of 263. Transthoracic echocardiography revealed a moderate circumferential pericardial effusion with a maximum of 1.8cm adjacent to the lateral wall of the left ventricle in the parasternal short axis view and no evidence of tamponade physiology. The patient did not show initial response to anti-inflammatory therapy, and was commenced on steroid therapy, and subsequently immunosuppressive therapy, namely azathioprine, to manage disease activity. This case brings to light a rare but significant side effect of mRNA vaccine, and whilst this case should not impede vaccination efforts, it highlights that whilst the majority of patients get transient self-limiting myocardial inflammation, rare cases of prolonged myopericarditis may occur which may require prolonged immunosuppression.