Sex: M
Vaccine: COVID19
Symptoms: Troponin I, Troponin increased, Viral test
Clinical narrative: perimyocarditis within 4 days of receiving a dose of BNT162b2 vaccine.; This is a literature report The full publication has been requested. This author reported similar events for eight patients. This is the third of eight reports.   A 17-year-old male with a history of mild perimyocarditis in 2014, presented to the ED with 1 day of retrosternal pressure. In the ED, his troponin was 0.45 ng/mL, and the ECG demonstrated normal sinus rhythm with no other abnormalities. TTE showed normal biventricular function. Patient had received his first BNT162b2 vaccine 14 days earlier. He was discharged with a 2-week course of ibuprofen with complete resolution of symptoms. He had no history of SARS-CoV-2 infection. Patient re-presented to the ED with retrosternal chest pressure 19 days after his first presentation. He received the second BNT162b2 dose 4 days before. Troponin-I level at his second presentation was 34.5 ng/mL. ECG demonstrated sinus rhythm with occasional premature ventricular contractions (PVCs), diffuse ST-segment elevations, and no PR depression. He was treated with 1 dose of intravenous immunoglobulin (IVIG). On telemetry, he had a single 4 beat episode of monomorphic ventricular tachycardia. TTE showed no significant valvular dysfunction, qualitatively normal biventricular systolic function, and no significant pericardial effusion. Cardiac MRI showed a late gadolinium enhancement pattern and edema consistent with acute myocarditis. The patient was found to be SARS-CoV-2 nucleocapsid IgG-positive and SARS-CoV-2 PCR-negative. Extensive infectious workup was negative, including adenovirus plasma PCR, CMV anti bodies, enterovirus plasma PCR, EBV titers, Leptospira antibodies, Lyme antibodies, Mycoplasma IgM, Parvovirus B19 PCR, Trypanosoma cruzi antibodies, and HIV antigen/antibody. Body mass index (kg/m2) 39.7, History of prior COVID-19 infection: No, Length of stay (hours) 95, Laboratories included: White blood cell count (Ref: 5-10) 10.4, Peak troponin-I (Ref: 0.00-0.08 ng/mL) 34.50, Discharge troponin-I (Ref: 0.00-0.08 ng/mL) 0.72, CKMB (Ref:0-3.5ng/mL) N/A, CPK (Ref: 33-145 IU/L) 523, d-dimer (Ref: 0.27-0.41 mmg/mL) N/A. COVID-19 testing: SARS-CoV-2 PCR Negative, SARS-CoV-2 spike IgM Negative, SARS-CoV-2 nucleocapsid IgG Positive. EKG: EKG findings Abnormal PR depression, diffuse ST-segment elevation. Imaging: Chest radiograph (cardiopulmonary findings) Negative; Left ventricular ejection fraction on ECHO 58, Pericardial effusion present No, Cardiac MRI performed Yes, Left ventricular ejection fraction on MRI 61, Myocardial edema on MRI (yes/no) Yes, Late gadolinium enhancement on MRI (yes/no) Yes, Treatment/intervention included: IVIG (intravenous immunoglobulin) and Scheduled NSAIDs (nonsteroidal anti-inflammatory drugs).  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. Pediatricians should consider myocarditis in the differential diagnosis of patients presenting with chest pain after receiving the BNT162b2 vaccine and be aware of the clinical implications and the need to report this potential adverse event. Currently, the association between perimyocarditis and the BNT162b2 vaccine is unproven but recent reports suggest there may be causality. This case series raises additional questions regarding appropriate recommendations for COVID-19 vaccination in adolescents with a prior history of perimyocarditis, of SARS CoV-2 infection (clinically or by serology), and of multisystem inflammatory syndrome associated with SARS-CoV-2 (MISC). It also poses the issue of whether patients who experience perimyocarditis post-BNT162b2 vaccine should receive booster SARS-CoV-2 vaccines in the future.   No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.; 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.