Vol 13, No 1 (2022)
Case report
Published online: 2022-05-09

open access

Page views 5293
Article views/downloads 690
Get Citation

Connect on Social Media

Connect on Social Media

Polyserositis (pericarditis and bilateral pleural effusion) after COVID-19 mRNA vaccine

Katarzyna Korzeniowska1, Artur Cieślewicz1, Anna Flotyńska1, Anna Jabłecka1
Hematology in Clinical Practice 2022;13(1).

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has been responsible for more than 5.5 million deaths worldwide. Vaccination is the most effective method of preventing this type of disease. The efficacy and safety of COVID-19 vaccines authorized in the European Union have been assessed in clinical trials that recruited many participants. As the number of vaccinated people increases, infrequent adverse effects are expected. We would like to report a case of polyserositis (pericarditis, and bilateral pleural effusion) observed a few days after administering the Pfizer BioNTech COVID-19 mRNA vaccine (Comirnaty®) in a 65-year-old man with no cardiovascular, metabolic or autoimmune disorders in his history. The incidence of myocarditis and pericarditis after COVID-19 mRNA vaccines is very low (combined reports from the USA and EU suggest the incidence of 1.02 × 10–5 and 7.61 × 10–6 respectively). Therefore, it is vital to inform people volunteering for vaccination to be aware of such symptoms as chest pain, breathlessness, or irregular forceful heartbeat. Moreover, the presence of these symptoms should alert healthcare professionals to the potential risk of pericarditis associated with the administration of the COVID-19 vaccine.

Article available in PDF format

View PDF Download PDF file

References

  1. World Health Organization. Weekly epidemiological update on COVID-19 — 25 January 2022. https://www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-19---25-january-2022 (January 31, 2022).
  2. COVID-19 vaccines: authorized European Medicines Agency . https://www.ema.europa.eu/en/human-regulatory/overview/public-health-threats/coronavirus-disease-covid-19/treatments-vaccines/vaccines-covid-19/covid-19-vaccines-authorised#authorised-covid-19-vaccines-section. (January 31, 2022).
  3. COVID-19 vaccine Comirnaty. Summary of product characteristics. https://www.ema.europa.eu/documents/product-information/comirnaty-epar-product-information_en.pdf (January 31, 2022).
  4. COVID-19 vaccine Spikevax. Summary of product characteristics. https://www.ema.europa.eu/documents/product-information/spikevax-previously-covid-19-vaccine-moderna-epar-product-information_en.pdf (January 31, 2022).
  5. COVID-19 vaccine Vaxzevria. Summary of product characteristics. https://www.ema.europa.eu/documents/product-information/vaxzevria-previously-covid-19-vaccine-astrazeneca-epar-product-information_en.pdf (January 31, 2022).
  6. COVID-19 vaccine Janssen. Summary of product characteristics. https://www.ema.europa.eu/documents/product-information/covid-19-vaccine-janssen-epar-product-information_en.pdf (January 31, 2022).
  7. Thomas SJ, Moreira ED, Kitchin N, et al. C4591001 Clinical Trial Group, C4591001 Clinical Trial Group. Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine. N Engl J Med. 2020; 383(27): 2603–2615.
  8. Voysey M, Clemens SA, Madhi SA, et al. Oxford COVID Vaccine Trial Group. Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK. Lancet. 2021; 397(10269): 99–111.
  9. Baden LR, Sahly HEl, Essink B, et al. Efficacy and Safety of the mRNA-1273 SARS-CoV-2 Vaccine. N Engl J Med. 2021; 384(5): 403–416.
  10. Sadoff J, Gray G, Vandebosch An, et al. ENSEMBLE Study Group. Safety and efficacy of single-dose Ad26.COV2.S Vaccine against Covid-19. N Engl J Med. 2021; 384(23): 2187–2201.
  11. Adler Y, Charron P. The 2015 ESC Guidelines on the diagnosis and management of pericardial diseases. Eur Heart J. 2015; 36(42): 2873–2874.
  12. Doctor NS, Shah AB, Coplan N, et al. Acute pericarditis. Prog Cardiovasc Dis. 2017; 59(4): 349–359.
  13. Linschoten M, Peters S, van Smeden M, et al. CAPACITY-COVID collaborative consortium. Cardiac complications in patients hospitalised with COVID-19. Eur Heart J Acute Cardiovasc Care. 2020; 9(8): 817–823.
  14. Tung-Chen Y. Acute pericarditis due to COVID-19 infection: an underdiagnosed disease? Med Clin (Barc). 2020; 155(1): 44–45.
  15. Kumar R, Kumar J, Daly C, et al. Acute pericarditis as a primary presentation of COVID-19. BMJ Case Rep. 2020; 13(8).
  16. Dimopoulou D, Spyridis N, Dasoula F, et al. Pericarditis as the main clinical manifestation of COVID-19 in adolescents. Pediatr Infect Dis J. 2021; 40(5): e197–e199.
  17. Faraj R, Belkhayat C, Bouchlarhem A, et al. Acute pericarditis revealing COVID-19 infection: case report. Ann Med Surg (Lond). 2021; 62: 225–227.
  18. Bhandari B, Neupane S, Khanal R, et al. COVID-19 pericarditis mimicking an acute myocardial infarction: a case report and review of literature. J Community Hosp Intern Med Perspect. 2021; 11(3): 315–321.
  19. Kaminski A, Albus M, Mohseni M, et al. A delayed case of pericarditis following recoveryfrom COVID-19 infection. Cureus. 2021; 13(4): e14397.
  20. Engler RJM, Nelson MR, Collins LC, et al. A prospective study of the incidence of myocarditis/pericarditis and new onset cardiac symptoms following smallpox and influenza vaccination. PLoS One. 2015; 10(3): e0118283.
  21. Comirnaty and Spikevax: possible link to very rare cases of myocarditis and pericarditis. European Medicines Agency. https://www.ema.europa.eu/en/news/comirnaty-spikevax-possible-link-very-rare-cases-myocarditis-pericarditis (January 31, 2022).
  22. COVID-19 subcommittee of the WHO Global Advisory Committee on Vaccine Safety (GACVS): updated guidance regarding myocarditis and pericarditis reported with COVID-19 mRNA vaccines. World Health Organization. https://www.who.int/news/item/09-07-2021-gacvs-guidance-myocarditis-pericarditis-covid-19-mrna-vaccines (January 31, 2022).
  23. Myocarditis and Pericarditis Following mRNA COVID-19 vaccination. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/myocarditis.html (January 31, 2022).
  24. King WW, Petersen MR, Matar RM, et al. Myocarditis following mRNA vaccination against SARS-CoV-2, a case series. Am Heart J Plus. 2021; 8: 100042.
  25. Hudson B, Mantooth R, DeLaney M. Myocarditis and pericarditis after vaccination for COVID-19. J Am Coll Emerg Physicians Open. 2021; 2(4): e12498.
  26. Khogali F, Abdelrahman R. Unusual presentation of acute perimyocarditis following SARS-COV-2 mRNA-1237 Moderna vaccination. Cureus. 2021; 13(7): e16590.
  27. Diaz GA, Parsons GT, Gering SK, et al. Myocarditis and pericarditis after vaccination for COVID-19. JAMA. 2021; 326(12): 1210–1212.
  28. Report Run Date: 21-Apr-2022, Page 1 COVID-19 mRNA Pfizer-BioNTech vaccine analysis print. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1050740/COVID-19_Pfizer-BioNTech_Vaccine_Analysis_Print_DLP_19.01.2022.pdf (January 31, 2022).
  29. Barda N, Dagan N, Ben-Shlomo Y, et al. Safety of the BNT162b2 mRNA Covid-19 vaccine in a nationwide setting. N Engl J Med. 2021; 385(12): 1078–1090.
  30. Pepe S, Gregory AT, Denniss AR. Myocarditis, pericarditis and cardiomyopathy after COVID-19 vaccination. Heart Lung Circ. 2021; 30(10): 1425–1429.
  31. Bozkurt B, Kamat I, Hotez PJ. Myocarditis with COVID-19 mRNA vaccines. Circulation. 2021; 144(6): 471–484.
  32. United States Department of Health and Human Services, Department of Health and Human Services (DHHS), Public Health Service (PHS), Food and Drug Administration (FDA)/Centers for Disease Control (CDC), Vaccine Adverse Event Reporting System (VAERS) 1990 — last Friday, CDC WONDER Online Database. https://wonder.cdc.gov/vaers.html (January 31, 2022).
  33. Centers for Disease Control and Prevention. COVID Data Tracker. https://covid.cdc.gov/covid-data-tracker/#vaccinations_vacc-total-admin-rate-total (January 31, 2022).
  34. EudraVigilance — European database of suspected adverse drug reaction reports. https://www.adrreports.eu/en/search_subst.html# (January 31, 2022).
  35. Kytö V, Sipilä J, Rautava P, et al. Clinical profile and influences on outcomes in patients hospitalized for acute pericarditis. Circulation. 2014; 130(18): 1601–1606.
  36. Das BB, Moskowitz WB, Taylor MB, et al. Myocarditis and pericarditis following mRNA COVID-19 vaccination: what do we know so far? Children (Basel). 2021; 8(7).
  37. European Centre for Disease Prevention and Control. COVID-19 Vaccine Tracker. https://vaccinetracker.ecdc.europa.eu/public/extensions/COVID-19/vaccine-tracker.html#distribution-tab (January 31, 2022).
  38. Luk A, Clarke B, Dahdah N, et al. Myocarditis and pericarditis after COVID-19 mRNA vaccination: practical considerations for care providers. Can J Cardiol. 2021; 37(10): 1629–1634.
  39. Losada I, González-Moreno J, Roda N, et al. Polyserositis: a diagnostic challenge. Intern Med J. 2018; 48(8): 982–987.
  40. Harris E, Shanghavi S, Viner T. Polyserositis secondary to COVID-19: the diagnostic dilemma. BMJ Case Rep. 2021; 14(9).
  41. Tawfik P, Gertner E, McEvoy CE. Severe polyserositis induced by the 13-valent pneumococcal conjugate vaccine: a case report. J Med Case Rep. 2017; 11(1): 142.
  42. Porcel JM, Bielsa S, Corral E, et al. Characteristics of pleural effusions in acute idiopathic pericarditis and post-cardiac injury syndrome. Ann Am Thorac Soc. 2016; 13(2): 298–300.
  43. Albert E, Aurigemma G, Saucedo J, et al. Myocarditis following COVID-19 vaccination. Radiol Case Rep. 2021; 16(8): 2142–2145.



Hematology in Clinical Practice