Sex: M
Vaccine: COVID19
Symptoms: Epstein-Barr virus antibody positive, Fibrin D dimer, HIV test, HIV test negative, Investigation
Clinical narrative: perimyocarditis/presented to the ED with left-sided chest pain and intermittent palpitations for approximately 1 day; This is a literature report. The full publication has been requested. This author reported similar events for eight patients. This is the second of eight reports.  A 16-year-old (also reported as 16.7-year-old) male with no past medical history presented to the ED with left-sided chest pain and intermittent palpitations for approximately 1 day. He denied fever, shortness of breath, or recent illness. There was no history of SARS-CoV-2 infection. Patient had received the second dose of BNT162b2 vaccine 3 days prior to presentation. His troponin-I was elevated at 4.82 ng/mL, and ECG showed diffuse ST elevation and PR-segment depression (demonstrating sinus rhythm with normal axis and intervals. Diffuse PR depressions and horizontal ST-segment elevations are illustrated). The patient was managed with ibuprofen with resolution of pain. TTE showed no structural abnormalities and qualitatively normal LVSF. Cardiac MRI findings were consistent with acute myocarditis, showing late gadolinium enhancement pattern and myocardial edema, normal biventricular size and function, and pericardial thickening. Further workup showed negative SARS-CoV-2 nucleocapsid IgG, negative human immunodeficiency virus (HIV) antigen/antibody, adenovirus PCR, enterovirus PCR, Lyme antibody titers, Leptospira immunoglobulin M (IgM), Trypanosoma cruziIgG, and Toxocara canis IgG. EBV antibody panel was consistent with past infection. CMV IgM was borderline-positive, but IgG was negative. RPP was negative. Mycoplasma IgM was positive; however, nasopharyngeal PCR was negative. The decision was made to treat with doxycycline for Mycoplasma infection, although the IgM was suspected to be a false-positive. The patient was discharged home on doxycycline, ibuprofen, and lansoprazole.   Demographic and clinical characteristics: Body mass index (kg/m2) 25.1. Past medical history (PMH) No. History of prior COVID-19 infection No. BNT162b2 vaccine dose # 2. Days between vaccine and symptom onset 3. Length of stay (hours) 71.  Laboratories: White blood cell count (Ref: 5-10) 4.3; Peak troponin-I (Ref: 0.00-0.08 ng/mL) 5.56; Discharge troponin-I (Ref: 0.00-0.08 ng/mL) 0.72; CKMB (Ref:0-3.5ng/mL) 61.5; d-dimer (Ref: 0.27-0.41 mmg/mL) 0.2.  COVID-19 testing: SARS-CoV-2 PCR Negative; SARS-CoV-2 spike IgM Negative; SARS-CoV-2 nucleocapsid IgG Positive  EKG findings Abnormal PR depression, diffuse ST-segment elevation. Imagine Chest radiograph (cardiopulmonary findings) Negative. Left ventricular ejection fraction on ECHO 55. Pericardial effusion present No. Cardiac MRI performed Yes. Left ventricular ejection fraction on MRI 60. Myocardial edema on MRI Yes. Late gadolinium enhancement on MRI Yes. Treatment/intervention: IVIG (intravenous immunoglobulin) No; Scheduled NSAIDs (nonsteroidal anti-inflammatory drugs) Yes.  DISCUSSION Herein described is the first case series from a single institution of 8 adolescent males with a diagnosis of perimyocarditis in the setting of recent BNT162b2 vaccination with no other identifiable cause.   No follow-up attempts are needed, information about batch number cannot be obtained; Sender's Comments: A contributory role of BNT162B2 to the event perimyocarditis cannot be excluded based on the plausible temporal relationship, product safety profile and lack of reported alternative explanation at this time. This case will be reassessed if additional information becomes available.  The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate.,Linked Report(s) : US-PFIZER INC-202101133568 Same article/ drug/ event and Different patient.