Sex: M
Vaccine: COVID19
Symptoms: Investigation, Magnetic resonance imaging heart, Pericarditis constrictive, SARS-CoV-2 antibody test, Venous pressure jugular
Clinical narrative: This is a literature report for the following literature source: "A RARE CASE OF CONSTRICTIVE PERICARDITIS FOLLOWING COVID-19 EXPOSURE AND VACCINATION", Journal of the American College of Cardiology, 2022; Vol:79 (9 Suppl.), pgs:2342, DOI:10.1016/S0735-1097%2822%2903333-2. A 67 year-old male patient received bnt162b2, administration date Mar2021 (Batch/Lot number: unknown) as dose 1, single and administration date Mar2021 (Batch/Lot number: unknown) as dose2, single for Covid-19 immunisation. Relevant medical history included: "atrial fibrillation" (unspecified if ongoing); "cryoablation" (unspecified if ongoing); "left atrial occlusion device" (unspecified if ongoing); "pericardiectomy on beating-heart, off-pump" (unspecified if ongoing), notes: his recovery was uneventful; "dyspnea" (unspecified if ongoing); "persistent cough" (unspecified if ongoing). Family history included: "COVID-19", start date: Apr2020 (unspecified if ongoing), notes: his wife tested positive for COVID-19. The patient's concomitant medications were not reported. The following information was reported: PERICARDITIS CONSTRICTIVE (medically significant), outcome "recovered", described as "CONSTRICTIVE PERICARDITIS FOLLOWING COVID-19 EXPOSURE AND VACCINATION". Therapeutic measures were taken as a result of pericarditis constrictive. The clinical course was reported as follows: Post infectious constrictive pericarditis is rare and thought to be secondary to chronic inflammation leading to scarring. A 67-year-old man with history of atrial fibrillation, cryoablation and left atrial occlusion device presented with complaints of dyspnea three months after his wife tested positive for COVID-19 in April 2020. Although he tested negative, he complained of a persistent cough. His exam was positive for elevated JVP, right ventricular heave and lower extremity swelling. ECG showed atrial fibrillation and transthoracic echocardiography (TTE) showed moderate tricuspid regurgitation and right ventricle dysfunction. Computed tomography of the chest was negative for pulmonary embolus. In December 2020, cardiac magnetic resonance imaging (CMR) showed normal biventricular function with no infiltrative or pericardial disease. Thoracentesis was negative for TB and malignancy but did show lymphocytic predominance. The patient received two doses of the Pfizer COVID-19 vaccine in March 2021 and his symptoms progressively worsened. Repeat TTE in July 2021 showed rapid early mitral valve filling and a septal bounce. Cardiac catheterization showed nonobstructive disease, deep "y" descents and discordance between left and right sided pressures. Repeat CMR showed a thickened pericardium. Decision-making: The patient was felt in retrospect to have had COVID-19 myocarditis even though his testing had been negative. It was concluded that the mRNA vaccine tipped the already inflamed pericardium over to a constrictive physiology. He underwent pericardiectomy on a beating-heart, off-pump, and his recovery was uneventful. Tissue exam confirmed a thickened pericardium with acute on chronic pericarditis. The CDC was contacted. On follow up patient symptoms had resolved. Conclusion: Constrictive pericarditis, although rare, can complicate viral pericarditis and should be considered in patients with COVID-19 exposure and/or after mRNA vaccine. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected. Sender's Comments: Based on the available reported information, the causal association between the event pericarditis constrictive and the suspect drug BNT162B2 cannot be excluded. 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.