key: cord-0884461-ci3ip047 authors: Mizoguchi, Tatsuya; Yokoi, Masashi; Shintani, Yasuhiro; Yamamoto, Junki; Mori, Kento; Fujita, Hiroshi; Ito, Tsuyoshi; Sugiura, Tomonori; Seo, Yoshihiro title: A case of an elderly female who developed subacute pleuropericarditis following BNT162b2 mRNA COVID-19 vaccination date: 2022-05-17 journal: J Cardiol Cases DOI: 10.1016/j.jccase.2022.04.020 sha: d2aaa0b10360a185f85632746513a10b7507b491 doc_id: 884461 cord_uid: ci3ip047 Despite the established safety of BNT162b2 coronavirus disease 2019 (COVID-19) vaccine, some rare but serious complications have been previously reported. Here, we report a rare case of an elderly female who developed subacute pleuropericarditis after the vaccination. An 88-year-old female experienced weight gain and dyspnea three days after the second dose of BNT162b2 vaccination, and one month later, presented to our hospital due to the exacerbation of the symptoms. Computed tomography showed remarkable pericardial and bilateral pleural effusions, and transthoracic echocardiogram visualized collapse signs of right and left atrium which indicates pre-tamponade. Percutaneous drainages of pericardial and pleural effusions stabilized her vital condition and revealed that all of them were exudative, indicating the presence of pleuropericarditis. Finally, we diagnosed this case as COVID-19 vaccine-associated pleuropericarditis because there were no signs of bacterial/viral infection or any other relevant causes except for the vaccination. When the pericardial and pleural effusions are concurrently found after COVID-19 vaccination, vaccine-associated pleuropericarditis should be considered as a differential diagnosis. The aggressive drainage of pericardial and pleural effusions could be helpful not only for diagnosis but also for treatment in the clinical management of COVID-19 vaccine-associated pleuropericarditis. LEARNING OBJECTIVE: Although the safety and efficacy of BNT162b2 have been widely accepted, it is clinically important to know the potential risk of side effects. When the pericardial and pleural effusions are concurrently found after the vaccination, coronavirus disease 2019 vaccine-associated pleuropericarditis should be considered as a differential diagnosis. The BNT162b2 mRNA vaccine has been developed to lessen the symptoms, complications, and morbidity associated with coronavirus disease 2019 (COVID-19) [1] . Although the safety and efficacy of BNT162b2 have been widely accepted [2] , it is clinically important to know the potential risk of side effects. Myocarditis and pericarditis have been reported as rare but serious complications following BNT162b2 vaccination [3] . However, the concurrent development of pericarditis and bilateral pleuritis, which is known as pleuropericarditis, after BNT162b2 vaccination has not been reported as far as we know. We herein report a case of an elderly female patient who developed pleuropericarditis following the second dose of BNT162b2 vaccination. An 88-year-old Japanese female experienced chest discomfort, dyspnea, and gain of weight three days after the second dose of BNT162b2 vaccination (COMIRNATY®, BioNTech/Pfizer, Mainz, Germany/New York, NY, USA). In the local clinic, although cardiomegaly on chest X-ray and the small amount of pericardial effusion on transthoracic echocardiogram were pointed out, she was observed without any medication. One month later, she was referred to our hospital by the clinic due to the J o u r n a l P r e -p r o o f exacerbation of dyspnea. She had no prior history of cardiac disease, pleural disease, hypothyroidism, autoimmune disease, or neoplasm. Initial vital signs were as follows: a body temperature of 36.3℃, O 2 saturation of 89% on room air with a respiratory rate of 20 breaths/minute, heart rate of 82 beats/minute, and blood pressure of 110/60 mmHg. Physical examination revealed jugular venous distension and bilateral leg edema. The presence of a paradoxical pulse was not apparent, and a pericardial friction rub was not audible. Chest X-ray showed an enlarged cardio-thoracic ratio of 76% and bilateral pleural effusions (Fig. 1A) . Chest computed tomography (CT) scan presented remarkable pericardial and bilateral pleural effusions without any signs of pneumonia, pulmonary tuberculosis, or lung cancer (Fig. 1B) . Whole-body CT screening interpreted by radiologists showed no signs of malignant tumors. Electrocardiogram (ECG) showed sinus rhythm, low QRS voltage, slight PR depression in leads Ⅱ, Ⅲ, aVF, and V3-6, and PR elevation in lead aVR, implying the presence of pericarditis (Fig. 2) . Safety and immunogenicity of two RNA-based Covid-19 vaccine candidates Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine Myocarditis with COVID-19 mRNA vaccines ESC Guidelines for the diagnosis and management of pericardial diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC)Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS) Myopericarditis in a previously healthy adolescent male following COVID-19 vaccination: a case report A case report: symptomatic pericarditis post-COVID-19 vaccination A case series of acute pericarditis following COVID-19 vaccination in the context of recent reports from Europe and the United States Diagnostic approach to pleural effusion in adults Pericardial and pleural effusions in congestive heart failure-anatomical, pathophysiologic, and clinical considerations Fatal multisystem inflammatory syndrome in adult after SARS-CoV-2 natural infection and COVID-19 vaccination None. The authors declare that there is no conflict of interest.