key: cord-0952871-5a0am9ve
authors: Lee, Chan-Hee; Kong, Eun-Jung
title: FDG PET/MRI of Acute Myocarditis After mRNA COVID-19 Vaccination
date: 2022-02-28
journal: Clin Nucl Med
DOI: 10.1097/rlu.0000000000004123
sha: 55f83884abb12a7fc63f8b47e18067cfeeee185e
doc_id: 952871
cord_uid: 5a0am9ve

A 22-year-old man visited the emergency department with chest pain. He had received a second dose of the coronavirus disease 2019 (COVID-19) mRNA (Moderna) vaccine 5 days prior. (18)F-FDG PET/MR revealed a focal FDG uptake and late gadolinium enhancement on the basal posterolateral wall of the left ventricle. Myocarditis after a COVID-19 vaccination has been reported predominantly after the second dose of mRNA vaccines in young men. This was a case of acute focal myocarditis after a COVID-19 mRNA vaccination, which was well-visualized by FDG PET/MRI.

A 22-year-old man visited the emergency department with chest pain. He had received a second dose of the coronavirus disease 2019 (COVID-19) mRNA (Moderna) vaccine 5 days prior. His cardiac troponin I was elevated to 5.99 ng/mL (reference range, 0-0.04 ng/mL). A polymerase chain reaction test for COVID-19 exhibited negative results. Electrocardiography revealed ST-segment depression and T-wave inversion in leads V1-4. Echocardiography revealed a normal left ventricular systolic function without any pericardial effusion. 18 F-FDG PET/MR was performed after careful patient preparation with a low carbohydrate diet followed by a 12-hour fasting. 1 That revealed a focal FDG uptake (SUV max , 2.12; arrows) and subepicardial late gadolinium enhancement (LGE, arrowheads) on the basal posterolateral wall of the left ventricle. Both FDG PET and LGE were concordant, suggesting focal myocardial inflammation. Fused FDG PET with LGE (A, C, E) and LGE (B, D, F) images. His symptoms and troponin I level improved with a nonsteroidal anti-inflammatory drug, and he was discharged without any symptoms on the fifth hospital day. Myocarditis after a COVID-19 vaccination has been reported predominantly in young men, and more commonly after a second dose of mRNA vaccines due to a stronger immune response as compared with the first dose. [2] [3] [4] [5] [6] Potential mechanisms of COVID-19 mRNA vaccine myocarditis include autoimmune and autoinflammatory responses, 2,7,8 autoantibody generation, 9 and molecular mimicry between the viral spike protein and selfantigens. 10, 11 The electrocardiography changes including ST depression in the precordial leads were presumed to be reciprocal changes of the ST elevation associated with the posterior wall injury of the left ventricle. This was a case of acute focal myocarditis after a COVID-19 mRNA vaccination, which was well-visualized by FDG PET/MRI.

Document Reading Group. A joint procedural position statement on imaging in cardiac sarcoidosis: from the cardiovascular and Inflammation & Infection Committees of the European Association of Nuclear Medicine, the European Association of Cardiovascular Imaging, and the American Society of Nuclear Cardiology

Myocarditis with COVID-19 mRNA vaccines

Myocarditis after BNT162b2 and mRNA-1273 vaccination

Patients with acute myocarditis following mRNA COVID-19 vaccination

Myocarditis following COVID-19 mRNA vaccination

Cardiac imaging of acute myocarditis following COVID-19 mRNA vaccination

The novel platform of mRNA COVID-19 vaccines and myocarditis: clues into the potential underlying mechanism

Could SARS-coronavirus-2 trigger autoimmune and/or autoinflammatory mechanisms in genetically predisposed subjects?

Circulating cardiac autoantibodies in dilated cardiomyopathy and myocarditis: pathogenetic and clinical significance

Vaccine-induced autoimmunity: the role of molecular mimicry and immune crossreaction

Potential antigenic cross-reactivity between SARS-CoV-2 and human tissue with a possible link to an increase in autoimmune diseases