Myopericarditis following mRNA COVID-19 Vaccination in Adolescents 12 through 18 Years of Age

Das, Bibhuti B.; Kohli, Utkarsh; Ramachandran, Preeti; Nguyen, Hoang H.; Greil, Gerald; Hussain, Tarique; Tandon, Animesh; Kane, Colin; Avula, Sarvani; Duru, Chioma; Hede, Sannya; Sharma, Kavita; Chowdhury, Devyani; Patel, Sunil; Mercer, Christopher; Chaudhuri, Nita Ray; Patel, Bhavi; Khan, Danyal; Ang, Jocelyn Y.; Asmar, Basim; Sanchez, Joselito; Bobosky, Karyssa Ann; Cochran, Clinton D.; Gebara, Bassam M.; Gonzalez Rangel, Ismael E.; Krasan, Graham; Siddiqui, Owais; Waqas, Muhammad; El-Wiher, Nidal; Freij, Bishara J.

OBJECTIVES: To characterize the clinical course and outcomes of children who developed probable myopericarditis after vaccination with the Pfizer- BioNTech (BNT162b2) COVID-19 mRNA vaccine. STUDY DESIGN: A cross-sectional study of 32 children, aged 12 through 18 years, diagnosed with probable myopericarditis following COVID-19 mRNA vaccination as per the CDC criteria for myopericarditis at 9 US centers between May 10, 2021 and June 20, 2021. We retrospectively collected the following data: demographics, SARS-CoV-2 virus detection or serologic testing, clinical manifestations, laboratory test results, imaging study results, treatment and time to resolutions of symptoms. RESULTS: Most (90%) cases followed the second dose of vaccine, and chest pain (100%) was the most common presenting symptom. Patients came to medical attention a median of 2 days (range: <1-20 days) after receipt of Pfizer mRNA COVID-19 vaccination. All adolescents had an elevated plasma troponin concentration. Echocardiographic abnormalities were infrequent, and 84% showed normal cardiac function at presentation. However, cardiac magnetic resonance imaging (CMR), obtained in 16 patients (50%), revealed that 15 (94%) had late gadolinium enhancement consistent with myopericarditis. Most were treated with ibuprofen or an equivalent NSAID for symptomatic relief, one patient was treated primarily with a corticosteroid orally and three patients were given a corticosteroid orally after initial administration of ibuprofen or NSAID; two patients also received intravenous immune globulin. Symptom resolution was observed within 7 days in all patients. CONCLUSIONS: Our data suggest that symptoms due to myopericarditis following mRNA COVID-19 vaccination tend to be mild and transient. Approximately one half of patients underwent CMR, which revealed evidence of myocardial inflammation despite a lack of echocardiographic abnormalities.