Partially Resolving Myocardial Fibrosis Five Months Following the mRNA COVID-19 Vaccine: An MRI Based Case Report

Abstract

Introduction: Myocarditis is a disease that has varying severity and its diagnosis or management can pose as a challenge to 
clinicians.  With over 250 million people receiving the mRNA covid vaccine, there have been rare reports of myocarditis or 
other cardiovascular involvement.Case: We report a 30-year-old healthy male who was hospitalized for chest pain 3 days after receiving the second dose of the covid-19 vaccination.  He had high cardiac laboratory markers (cardiac troponin I peak of 22 ng/mL, normal <0.03 ng/mL) with dynamic ST segment elevations in the inferior and lateral leads.  He had a subsequent coronary angiogram and echocardiogram that were normal with elevated inflammatory markers and hence, was diagnosed with myocarditis.  He had a cardiac 
magnetic resonance (CMR) study approximately 8 weeks later (from the date of his second covid vaccine dose) that showed 
prominent mid to epicardial lateral wall fibrosis corresponding to similar ECG territory with normal T1 and T2 mapping.  A 
repeat CMR was performed 5 months later (from the second vaccine dose) that showed persistent, though partially resolving 
fibrosis, despite the full resolution of all symptoms and biomarkers.Conclusion: This case demonstrates acute myocarditis following the second dose of the mRNA covid-19 vaccination with evidence of persistent fibrosis on CMR 2 months later and on follow-up CMR scan 5 months from administration of the second dose of the vaccine.  Furthermore, it demonstrates correlation of scar territory on CMR with initial ECG changes and lingering natural course and an insidious recovery as well as the utility of CMR in clinical management.