Presentation
A 22-year-old male with past medical history of Coxsackie myocarditis in 2019 presented to the emergency department with acute chest pressure and diaphoresis. He described his chest pain as squeezing with radiation to the back. The patient denied dyspnea, edema, and lightheadedness. Physical examination and vital signs were within normal limits. Cardiovascular exam showed regular rate, normal rhythm, S1, S2 sounds, and no pericardial rub. He was taking no medications and had received his second dose of the Pfizer (BNT162b2) mRNA Coronavirus-19 disease (COVID-19) vaccine 3 days prior to symptoms onset. Laboratory examination showed high sensitivity C-reactive protein (hs-CRP) (3.15 mg/L), troponin (126 ng/mL) and brain natriuretic peptide (105 pg/mL) levels were all elevated. Severe acute respiratory syndrome-Coronavirus-2 (SARS-CoV-2) IgG test was positive indicative of prior infection with COVID-19. Electrocardiogram (ECG) showed diffuse ST-segment elevation suggestive of pericarditis. CXR was negative. Bedside echocardiography (Echo) demonstrated mildly reduced ejection fraction (EF) (45%). Cardiac magnetic resonance imaging (CMR) identified a small pericardial effusion, and profound basal inferolateral and lateral myocardial involvement (Figure 1A).Given his clinical and imaging findings, he was diagnosed with perimyocarditis secondary to COVID-19 vaccination. He was prescribed Aspirin 650 mg TID, colchicine 0.6 mg BID, and 1 month prednisone taper (30 mg). At 6 week follow-up, the patient noted his pain was significantly improved. The patient had completed his steroid taper and discontinued aspirin therapy due to gastrointestinal distress. Laboratory markers and ECG were normal. Echo showed EF recovery(Video 1). Repeat CMR demonstrated interval improvement in pericardial effusion and delayed enhancement (Figure 1B) . His colchicine was tapered to 0.6 mg daily and he was told to follow up in 4 months.