Permanent Myocardial Fibrosis One-Year Following the mRNA COVID-19 Vaccine: An MRI Based Case Report
Keywords:
Cardiac magnetic resonance imaging, CMR, Fibrosis, Covid vaccine, MyocarditisAbstract
Introduction: Myocarditis is a disease that has varying severity. With over 250 million people receiving the m-RNA covid
vaccine, there have been rare reports of myocarditis or other cardiovascular involvement. However, there is scant long term
follow-up data. Case: We report a 30-year-old otherwise 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 infero-lateral wall fibrosis (corresponding to the similar territory seen via
electrocardiogram) 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.
A third CMR study was performed 1 year from initial presentation that showed permanent though lessened fibrosis. The scar
pattern on CMR is despite the normalization of all symptoms, cardiac and inflammatory biomarkers, and echocardiography in
disease surveillance.
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