Chest pain and Raynaud's phenomenon after COVID-19 vaccination in a patient previously diagnosed with systemic lupus erythematosus: a case report

被引:1
作者
Kawano, Hiroaki [1 ]
Umeda, Masataka [2 ]
Okano, Shinji [3 ]
Kudo, Takashi [4 ]
机构
[1] Nagasaki Univ, Grad Sch Biomed Sci, Dept Cardiovasc Med, 1-7-1 Sakamoto, Nagasaki, Nagasaki 8528501, Japan
[2] Nagasaki Univ, Grad Sch Biomed Sci, Dept Immunol & Rheumatol, 1-7-1 Sakamoto, Nagasaki, Nagasaki 8528501, Japan
[3] Nagasaki Univ Hosp, Dept Pathol, 1-7-1 Sakamoto, Nagasaki, Nagasaki 8528501, Japan
[4] Nagasaki Univ, Atom Bomb Dis Inst, Dept Radioisotope Med, 1-12-4 Sakamoto, Nagasaki 8528523, Japan
关键词
Case report; COVID-19; vaccination; Pathology; Spike protein; SLE;
D O I
10.1093/ehjcr/ytad102
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background Cardiovascular events, including pericarditis, myocarditis, and myocardial ischaemia, have been reported as complications following COVID-19 vaccination. Case summary A 28-year-old Japanese woman diagnosed 10 years earlier with systemic lupus erythematosus and antiphospholipid syndrome was admitted to our hospital because of chest pain and Raynaud's phenomenon. She had received a second dose of the COVID-19 BNT162b2 mRNA vaccine 28 days earlier. I-123-beta-methyl iodophenyl pentadecanoic acid (BMIPP) and (201)thallium dual myocardial single-photon emission computed tomography demonstrated mildly reduced perfusion of BMIPP in the mid-anterior wall of the left ventricle. Coronary angiography revealed normal coronary arteries; additionally, an endomyocardial biopsy was performed. Histopathological evaluation revealed a normal myocardium without cell infiltration. However, immunostaining for the severe acute respiratory coronavirus (SARS-CoV)/severe acute respiratory coronavirus 2 (SARS-CoV-2) spike protein was positive in the small intramural coronary arteries. The administration of azathioprine (50 mg/day) and amlodipine (5 mg/day) and increases in her prednisolone (10 mg/day) and aspirin doses led to improvements in the symptoms of the patient. Discussion Our data lead us to speculate that two events in the timeline of the patient, namely, receiving COVID-19 vaccination and the presence of SARS-CoV/SARS-CoV-2 spike protein in small intramural coronary arteries, may be related to the myocardial microangiopathy observed in this patient.
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