ABSTRACT
SESSION TITLE: Issues After COVID-19 Vaccination Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Immune mediated vaccine related pericarditis reports have been well documented;albeit rare and generally well tolerated, it remains a real complication with possible devastating impacts. The incidence has increased even more with the covid vaccine.3 Here we describe a 72 year old female that received her 4th BNT162b2 dose, 5 months after the 3rd dose, and subsequently developed pericarditis. CASE PRESENTATION: 72 year old female, previously well, who presented with a 3 day history of central, sticking chest pain associated with exertional dyspnea, cough, palpitations and malaise. She denied any coryzal symptoms. On presentation she was hemodynamically stable but hypoxic and tachycardic. Laboratory investigations revealed leucocytosis and troponinemia of 0.13ng/ml. ECG showed diffuse ST elevations. A transthoracic echo showed a small pericardial effusion with normal LV and RV function, EF 60-65% and a CT Pulmonary Angiogram revealed a small sub-segmental pulmonary embolism with atelectasis and trace effusions. On further questioning she revealed that the symptoms started 3 days after she received her 2nd booster dose of the Pfizer covid vaccine. She was started on colchicine and apixaban and was discharged home with follow-up. Two days after discharge the patient represented to the hospital with worsening chest pain. Investigations revealed worsening leucocytosis and increased inflammatory markers (CRP 303mg/L, ESR 62mm/h). A new finding of a small pericardial effusion and bilateral pleural effusions with consolidations were noted on a repeat CT scan. Decision was made to continue colchicine and commence prednisone. Other infectious and inflammatory causes of pericarditis were ruled out. The COVID spike IgG was negative and the NAAT Cov 2 IgG showed titres >250 (<50). DISCUSSION: The exact pathogenesis of the COVID-19 vaccine-induced pericarditis remains unknown. It is thought that mRNA vaccines produce a large number of antibodies which elicit a multi-system inflammatory response1;despite this, steroid therapy remains controversial given the risk of recurrent pericarditis.2 A shorter vaccine interval has been associated with adverse outcomes. CDC extended the dosing interval in young persons to reduce the risk of severe myocarditis;however the interval for persons 65 years or more and immunocompromised remained unchanged. Our case and the identical case described by Singh et al1 reinforces the need to determine the best time interval for administration of the covid booster vaccines;especially in patients more than 65 years. CONCLUSIONS: More research needs to be done as to the most appropriate interval between booster doses to reduce the inflammatory complications related to the vaccine. A consideration should also be made to determine if the measurement of SARS COV-2 IgG spike titres have any role in determining the timing of subsequent booster doses. Reference #1: Singh A, Nguyen L, Everest S, et al. (February 12, 2022) Acute Pericarditis Post mRNA-1273 COVID Vaccine Booster. Cureus 14(2): e22148. DOI 10.7759/cureus.22148 Reference #2: Hajjo R., Sabbah D.A., Bardaweel S.K., Tropsha A. Shedding the Light on Post-Vaccine Myocarditis and Pericarditis in COVID-19 and Non-COVID-19 Vaccine Recipients. Vaccines. 2021;9:1186. doi: 10.3390/vaccines9101186. Reference #3: Diaz GA, Parsons GT, Gering SK, Meier AR, Hutchinson IV, Robicsek A. Myocarditis and Pericarditis After Vaccination for COVID-19. JAMA. 2021 Sep 28;326(12):1210-1212. doi: 10.1001/jama.2021.13443. PMID: 34347001;PMCID: PMC8340007. DISCLOSURES: No relevant relationships by Zachary Banbury No relevant relationships by Michael Basir No relevant relationships by Alexandra Gottdiener No relevant relationships by Janeen Grant-Sittol No relevant relationships by Srikant Kondapaneni No relevant relationships by Ross Lavine No relevant relationships by Anesha White