ABSTRACT
A young woman in her mid-40s was referred by her primary care physician for fever, worsening shortness of breath, pleuritic chest pain and tachycardia. CT angiogram of the chest revealed a large pericardial effusion. Echocardiogram confirmed tamponade physiology despite her being haemodynamically stable. She had an emergency pericardiocentesis which revealed evidence of a haemorrhagic pericardial effusion. However, the patient was still symptomatic after treatment and had to undergo video-assisted thoracoscopic surgery with a pericardial window and chest tube. Postoperatively, her fevers resolved. Pan-culture was initially negative, and all antibiotics were discontinued. Acid-fast bacilli cultures later grew Mycobacterium avium complex. She continued to have chest discomfort postoperatively, but follow-up CT of the chest 3 months postoperatively showed continued resolution of her pericardial effusion. The patient's symptoms improved, and she has had no recurrence of effusion without the need for anti-tuberculosis drugs.
Subject(s)
Cardiac Tamponade , Mycobacterium avium-intracellulare Infection , Pericardial Effusion , Pericarditis , Female , Humans , Cardiac Tamponade/diagnostic imaging , Cardiac Tamponade/etiology , Pericardial Effusion/diagnosis , Mycobacterium avium Complex , Mycobacterium avium-intracellulare Infection/complications , Mycobacterium avium-intracellulare Infection/diagnosis , Mycobacterium avium-intracellulare Infection/drug therapy , Pericarditis/diagnosis , Pericarditis/diagnostic imaging , FeverABSTRACT
Vaccine-associated myocarditis is becoming increasingly documented as a complication of the messenger ribonucleic acid (mRNA) vaccination platform. This complication so far has been found to predominantly affect the younger male population within seven days of receiving the second dose of an mRNA vaccine. We present a case of a 45-year-old male found to have clinical, biochemical, and radiological evidence of myocarditis three days after receipt of the second dose of the Moderna COVID-19 vaccine. Troponin I and inflammatory marker trends, in addition to the use of cardiac MRI imaging, was important in making the diagnosis. Symptom resolution was achieved after two months of colchicine and anti-heart failure medications. We highlight the occurrence of this rare vaccine complication in an endeavor to stress the need for further research to better understand this condition so that better guidance can be provided to the medical community on how best to screen and manage it.
