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Simultaneous Occurrence of Immune- Mediated Thrombocytopenia and Myocarditis After mRNA-1273 COVID-19 Vaccination: A Case Reportopen access

Authors
Bae, Dae-HwanKim, MinLee, Dae InLee, Ju-HeeKim, SangminLee, Sang YeubBae, Jang-WhanHwang, Kyung-KukKim, Dong-WoonCho, Myeong-Chan
Issue Date
May-2022
Publisher
KOREAN ACAD MEDICAL SCIENCES
Keywords
Thrombocytopenia; Myocarditis; COVID-19; Vaccination
Citation
JOURNAL OF KOREAN MEDICAL SCIENCE, v.37, no.21
Journal Title
JOURNAL OF KOREAN MEDICAL SCIENCE
Volume
37
Number
21
URI
https://scholarworks.bwise.kr/cau/handle/2019.sw.cau/61335
DOI
10.3346/jkms.2022.37.e169
ISSN
1011-8934
1598-6357
Abstract
With the global spread of severe acute respiratory syndrome coronavirus 2, several vaccines were developed; messenger RNA (mRNA) vaccines have recently been widely used worldwide. However, the incidence of myocarditis following mRNA vaccination is increasing; although the cause of myocarditis has not yet been clearly identified, it is presumed to be caused by a problem in the innate immune system. Immune-mediated thrombocytopenia (ITP) after vaccination is rare but has been reported and is also assumed to occur by the same mechanism. We report the first case of simultaneous myocarditis and ITP after mRNA vaccination. A 38-year-old woman presented with chest pain, mild dyspnea, and sweating after vaccination with mRNA-1273 vaccine (Moderna) 4 days prior to admission. Upon admission to the emergency department, cardiac enzymes were elevated; blood test performed 5 months ago showed normal platelet count, but severe thrombocytopenia was observed upon admission. After administration of intravenous immunoglobulin, the platelet count improved; subsequently, myocarditis was observed on endomyocardial biopsy. Thus, myocarditis and ITP were judged to have occurred simultaneously due to the expression of the innate immune system markers after mRNA vaccination. The patient was discharged on day 6 of admission.
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