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Autoimmune Rheumatic Disease Flares with Myocarditis Following COVID-19 mRNA Vaccination: A Case-Based Review.
Lai, Yi Wye; Chua, Choon Guan; Lim, Xin Rong; Francis, Prabath Joseph; Xu, Chuanhui; Howe, Hwee Siew.
  • Lai YW; Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore 308433, Singapore.
  • Chua CG; Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore 308433, Singapore.
  • Lim XR; Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore 308433, Singapore.
  • Francis PJ; Department of Cardiology, Tan Tock Seng Hospital, Singapore 308433, Singapore.
  • Xu C; Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore 308433, Singapore.
  • Howe HS; Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore 308433, Singapore.
Vaccines (Basel) ; 10(10)2022 Oct 21.
Article in English | MEDLINE | ID: covidwho-2082063
ABSTRACT
Since the introduction of coronavirus disease 2019 (COVID-19) messenger ribonucleic acid (mRNA) vaccines, there have been multiple reports of post-vaccination myocarditis (mainly affecting young healthy males). We report on four patients with active autoimmune rheumatic diseases (ARDs) and probable or confirmed myocarditis following COVID-19 mRNA vaccination managed at a tertiary hospital in Singapore; we reviewed the literature on post-COVID-19 mRNA vaccination-related myocarditis and ARD flares. Three patients had existing ARD flares (two had systemic lupus erythematosus (SLE), one had eosinophilic granulomatosis polyangiitis (EGPA)), and one had new-onset EGPA. All patients recovered well after receiving immunosuppressants comprising high-dose glucocorticoids, cyclophosphamide, and rituximab. Thus far, only one case of active SLE with myocarditis has been reported post-COVID-19 mRNA vaccination in the literature. In contrast to isolated post-COVID-19 mRNA vaccination myocarditis, our older-aged patients had myocarditis associated with ARD flares post-COVID-19 vaccination (that occurred after one dose of an mRNA vaccine), associated with other features of ARD flares, and required increased immunosuppression to achieve myocarditis resolution. This case series serves to highlight the differences in clinical and therapeutic aspects in ARD patients, heighten the vigilance of rheumatologists for this development, and encourage the adoption of risk reduction strategies in this vulnerable population.
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Full text: Available Collection: International databases Database: MEDLINE Type of study: Case report / Prognostic study Topics: Long Covid / Vaccines Language: English Year: 2022 Document Type: Article Affiliation country: Vaccines10101772

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Case report / Prognostic study Topics: Long Covid / Vaccines Language: English Year: 2022 Document Type: Article Affiliation country: Vaccines10101772