Sex: M
Vaccine: COVID19
Symptoms: Echocardiogram, Haemophagocytic lymphohistiocytosis, Myopericarditis
Clinical narrative: HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS; MYOPERICARDITIS; This spontaneous report was received from literature. This report concerned a 63-year-old male. The patient's weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, and batch number were not reported) dose (dose series 1), start therapy date were not reported for covid-19 prophylaxis.  The batch number was not reported. The company is unable to perform follow up to request batch/lot numbers. No concomitant medications were reported.  The patient developing increased weakness and myalgias 1 week post influenza, COVID, and RSV vaccination simultaneously. He was found to be in shock with significant metabolic acidosis and new onset A-fib with RVR. He was found to have multi-system organ involvement with an AKI, worsening respiratory failure, and non-cholestatic transaminitis requiring vasopressor initiation and intubation ultimately for worsening hypoxemic respiratory failure. Hematologic derangements included severe thrombocytopenia and a grossly elevated ferritin of over 77,000. This constellation of findings in the setting of recent vaccination prompted the concern for HLH; definitive IL-2 receptor assay was ordered which returned grossly elevated. The patient demonstrated response to aggressive resuscitation and a systemic steroid course with improvement including physiologic parameters and organ functions. Il-2 receptor values continued to downtrend and improvement in the pericardial effusion without drainage. On an unspecified date, the patient experienced hemophagocytic lymphohistiocytosis and myopericarditis (dose series 1).  Laboratory data (dates unspecified) included: Echocardiogram showed a moderate circumferential pericardial effusion without evidence of tamponade. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the hemophagocytic lymphohistiocytosis and myopericarditis was not reported. Conclusion: HLH is a rare but life-threatening immune activation state that has been reported following COVID and influenza vaccinations. Myopericarditis is also a very rare but described phenomenon following COVID vaccination. To the best of the authors' knowledge, this is the first case in an adult describing HLH and myopericarditis following simultaneous COVID, influenza, and RSV vaccinations. Clinicians should consider these disease entities early in undertaking meaningful diagnostic workup and implementing management strategies early to yield favorable outcomes. This report was serious (Other Medically Important Condition, and Life Threatening).; Sender's Comments: V0:, Haemophagocytic lymphohistiocytosis: The event has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event. Specifically: CONMEDS-OTHER SUSPECT DRUGS. Therefore, this event is considered inconsistent with vaccine administration. Myopericarditis:  The event has a compatible/suggestive temporal relationship, and is labeled. There are other factors more likely to be associated with the event. Specifically: CONMEDS-OTHER SUSPECT DRUGS. Therefore, this event is considered inconsistent with vaccine administration.