J Korean Med Sci.  2022 May;37(21):e169. 10.3346/jkms.2022.37.e169.

Simultaneous Occurrence of ImmuneMediated Thrombocytopenia and Myocarditis After mRNA-1273 COVID-19 Vaccination: A Case Report

• Bae DH
• Kim M
• Lee DI
• Lee JH
• Kim S
• Lee SY
• Bae JW
• Hwang KK
• Kim DW
• Cho MC

• KMID: 2530114
• DOI: http://doi.org/10.3346/jkms.2022.37.e169

Abstract

With the global spread of severe acute respiratory syndrome coronavirus 2, several vaccines were developed; messenger RNA (mRNA) vaccines have recently been widely used worldwide. However, the incidence of myocarditis following mRNA vaccination is increasing; although the cause of myocarditis has not yet been clearly identified, it is presumed to be caused by a problem in the innate immune system. Immune-mediated thrombocytopenia (ITP) after vaccination is rare but has been reported and is also assumed to occur by the same mechanism. We report the first case of simultaneous myocarditis and ITP after mRNA vaccination. A 38-year-old woman presented with chest pain, mild dyspnea, and sweating after vaccination with mRNA-1273 vaccine (Moderna) 4 days prior to admission. Upon admission to the emergency department, cardiac enzymes were elevated; blood test performed 5 months ago showed normal platelet count, but severe thrombocytopenia was observed upon admission. After administration of intravenous immunoglobulin, the platelet count improved; subsequently, myocarditis was observed on endomyocardial biopsy. Thus, myocarditis and ITP were judged to have occurred simultaneously due to the expression of the innate immune system markers after mRNA vaccination. The patient was discharged on day 6 of admission.

Keyword

Thrombocytopenia; Myocarditis; COVID-19; Vaccination

Figure

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  Fig. 1 Electrocardiogram and coronary angiography of the patient at admission. (A) Initial electrocardiogram, (B) Left coronary artery, (C) Right coronary artery.

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  Fig. 2 Histopathology of the heart of interventricular septum. (A) Hematoxylin and eosin stains show a small amount of lymphohistiocytic infiltration between muscle fibers. (B) Leukocyte common antigen immunohistochemistry stain shows interstitial lymphocyte infiltration.

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  Fig. 3 Cardiac magnetic resonance imaging of myocarditis. (A) T2 imaging shows high signal intensity on mid of anterior-inferoseptal segment. (B) Image with late gadolinium enhancement.

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