SEVERE MYOCARDITIS WITH CARDIOGENIC SHOCK IN ADULT-ONSET STILL'S DISEASE AFTER mRNA COVID-19 VACCINATION: A CASE OF ATYPICAL PRESENTATION
Rheumatology (United Kingdom)
; 62(Supplement 2):ii133-ii134, 2023.
Article
in English
| EMBASE | ID: covidwho-2323978
ABSTRACT
Background/Aims Adult-onset Still's disease is a systemic inflammatory disease of unknown aetiology. Post-COVID-19 vaccine adult-onset Still's disease has been reported and was associated with only mild myocarditis. Here we report the first case of adult-onset Still's disease after mRNA COVID-19 vaccination presenting with severe myocarditis with acute heart failure and cardiogenic shock. Methods We described the case history of the patient. Results A 72-year-old Chinese woman developed gradual onset of fever, shortness of breath, sore throat, generalised arthralgia, malaise and poor appetite 15 days after receiving the first dose of BNT162b2 mRNA COVID-19 vaccine. Physical examination revealed fever, bilateral ankle oedema and elevated jugular venous pressure. Significant investigation results are shown in Table 1. Extensive viral panel tests (including enterovirus, influenza and cytomegalovirus) were all negative. Echocardiography showed severely reduced left ventricular ejection fraction of 20%. The acute heart failure was complicated by cardiogenic shock requiring intensive care unit admission. Myocarditis was later diagnosed. Although the heart condition subsequently improved, there were persistent fever and arthralgia, as well as the development of generalised maculopapular skin rash. In view of that, series of investigations were performed, which revealed persistent neutrophilic leucocytosis, hyper-ferritinaemia and liver function derangement, while autoimmune panel was grossly unremarkable and septic/viral workup was negative (Table 1). Contrast PET-CT scan showed no features of malignancy. Adult-onset Still's disease was diagnosed, and the patient was treated with oral prednisolone 40mg daily. The patient's condition responded to the treatment;the fever subsided and the leucocyte count and inflammatory markers were normalised, and she was subsequently discharged. Three months after discharge, the patient was clinically well with prednisolone tapered down to 5mg daily. Reassessment echocardiogram showed full recovery with LVEF 60%. Conclusion Severe myocarditis with acute heart failure and cardiogenic shock is a possible initial presentation of adult-onset Still's disease after mRNA COVID-19 vaccination. After exclusion of more common aetiologies, it is important to consider adult-onset Still's disease as one of the differential diagnoses in the presence of compatible features following COVID-19 vaccination, such that appropriate and timely workup and treatment can be offered. (Table Presented).
acute heart failure; adult onset Still disease; aged; ankle edema; appetite; arthralgia; cancer patient; cardiogenic shock; case report; central venous pressure; Chinese; clinical article; complication; conference abstract; coronavirus disease 2019; Cytomegalovirus; diagnosis; differential diagnosis; drug therapy; dyspnea; echocardiography; Enterovirus; female; fever; heart left ventricle ejection fraction; human; human cell; influenza; intensive care unit; leukocyte count; leukocytosis; liver function; malaise; malignant neoplasm; myocarditis; neutrophil; nonhuman; physical examination; positron emission tomography-computed tomography; rash; sore throat; vaccination; messenger RNA; prednisolone; tozinameran
Full text:
Available
Collection:
Databases of international organizations
Database:
EMBASE
Type of study:
Etiology study
/
Prognostic study
Topics:
Long Covid
/
Vaccines
Language:
English
Journal:
Rheumatology (United Kingdom)
Year:
2023
Document Type:
Article
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