Clinical and Medical Case Reports

Myopericarditis and pulmonary thrombosis after administration of the BNT162b2 vaccine against COVID-19 in a carrier of familial Mediterranean Fever

Abstract

Elisabeth Gomez Moyano, German Alegre-Garcia, Isabel Pineiro Uribe, Beatriz Perez-Villardon, Javier Mora-Robles, Manuel Jimenez-Navarro

Based on the current interest in the complications associated with vaccination against COVID-19, we present this case report of great interest that shows a carrier of familial Mediterranean fever who suffered myopericarditis and pulmonary thrombosis after administration of the BNT162b2 vaccine against COVID-19.

Certain autoimmune disorders may be triggered by COVID-19 vaccination in genetically susceptible persons. A 40-year-old woman had a history of deep vein thrombosis in 2006 coinciding with taking oral contraceptives, and a daughter with familial Mediterranean fever. In January 2021, as part of the COVID-19 vaccination program, she received her first dose of the BNT162b2 vaccination. Thirteen hours after the second dose she presented at the hospital with oppressive chest pain and fever and after several tests, including a cardiac MRI, she was diagnosed of myopericarditis and pulmonary thrombosis. The patient was heterozygous for the c.1772T>CM variant of gene MEFV.

Steroids and immunoglobulins were started, plus rivaroxaban, ivabradine and colchicine, resulting in slow improvement of the symptoms.

Cases have been reported of myocarditis and pericarditis after vaccination with live virus, like smallpox or flu, and more recently with SARS Cov-2 vaccination. Thrombotic events associated with COVID-19 vaccines are currently being carefully studied by the pharmacovigilance systems. The temporal association with vaccination, the serological pattern of immunization, plus the exclusion of other causes must be thoroughly evaluated.

The greater frequency of cases of myocarditis and pericarditis after RNA vaccination in Israel compared to other geographical areas may be related with ethnic and genetic differences. Indeed, the incidence of familial Mediterranean fever is greater in Israel, Armenia, Turkey and other Mediterranean countries. Further study of this would be interesting.