Case:
An 18-year-old male patient suffered from persistent fever and chest pain 3 days after the second dose of the Pfizer-BioNTech mRNA COVID-19 vaccine. His electrocardiograpy (ECG) and hemogram were normal. Peak cardiac troponinI/CRP was 44.1 ng/L/44.1 mg/L. No lymphocytosis, neutrophilia, monocytosis, eosinophilia were observed.
There was a minimal pericardial effusion on echocardiography with the normal systolic and diastolic functions.
COVID-19 PCR test, EBV, CMV, Toxoplasma, Rubella, HIV, AntiHCV, HbsAg, Rubeola and Mumps serological tests were negative.
The patient was considered as myopericarditis. Metoprolol-perindopril-colchicine and non-steroidal anti-inflammatory treatment were started.
The SE and CMR examinations were performed during the patient’s first hospitalization and control SE was performed just before discharge.
CMR showed on T2-weighted imaging, increased bright signal intensity as myocardial edema and increased global early gadolinium enhancement ratio between myocardium and skeletal muscle as myocardial injury, especially on anterior wall, minimal pericardial effusion and depressed sytolic function as left ventriculer ejection fraction (LVEF) 44.3%. These findings were in favor of acute myocarditis(Figure 1).
Although traditional-2D and doppler echocardiographic(TE) findings were normal, depressed circumflexian and longitudinal strain values ​​were observed in the SE on anterior wall (Figure 2).
In the follow-up of the patient, TE findings were still normal, while a moderate increase in strain values ​​was observed before discharge(Figure 3).
The patient was discharged on the 7th day with recovery after treatment. All examinations performed during the treatment process were performed with the informed consent of the patient.