Can the Coronavirus Disease 2019 (COVID-19) vaccine cause pericarditis in a 20-year-old?

From the Guidelines

The COVID-19 vaccine could potentially cause pericarditis in a 20-year-old, though this is a rare side effect, with the highest reported rates of postvaccination myocarditis observed in male individuals aged 18-24 years, at 50.5 cases per million following the second vaccine dose. Myocarditis and pericarditis following COVID-19 vaccination occur most commonly in male adolescents and young adults, typically after the second dose of an mRNA vaccine (Pfizer-BioNTech or Moderna) 1. Symptoms usually appear within a week after vaccination and include chest pain, shortness of breath, and palpitations. If pericarditis is suspected, the patient should seek immediate medical attention for evaluation, which typically includes an ECG, echocardiogram, and blood tests for cardiac markers and inflammatory indicators.

Key Considerations

• The risk of myocarditis after COVID-19 vaccination is higher in males, with a median age of 19 years, and 90% of cases being male 1.
• The incidence of postvaccination myocarditis after at least one dose of a COVID-19 mRNA vaccine was 21 cases per million for the all-comer population and 107 cases per million for male individuals aged 16-29 years 1.
• Treatment generally involves NSAIDs like ibuprofen (600-800mg three times daily) or aspirin (650-975mg every 4-6 hours) for 1-2 weeks, with colchicine (0.6mg once or twice daily for 3 months) sometimes added for persistent symptoms.

Management and Recommendations

• Most cases resolve completely with conservative management, and the risk of pericarditis from COVID-19 infection itself is significantly higher than from vaccination, so vaccination is still recommended for most people despite this rare risk.
• Accrued observational data also suggest that rates of postvaccination myocarditis may differ between the 2 mRNA vaccines (BNT162b2 [Pfizer-BioNTech] and mRNA-1273 [Moderna]), particularly after the second dose, with higher rates observed with the mRNA-1273 (Moderna) vaccine 1.

From the Research

Pericarditis and COVID-19 Vaccination

• Pericarditis has been reported as a rare side effect of COVID-19 vaccination, with a case report describing a 20-year-old patient presenting with typical symptoms of pericarditis 7 days after receiving the first dose of the Pfizer-BioNTech vaccine 2.
• The incidence of pericarditis post-vaccination is rare, with limited reporting in previous literature, and no causal relationship has yet to be established due to the small number of cases 2.
• Other studies have also reported cases of myopericarditis following COVID-19 vaccination, particularly in adolescents and young adults, with men being affected more frequently 3, 4.
• The clinical course of vaccine-related myopericarditis appears to be mild in most cases, with patients presenting with chest pain, shortness of breath, and fever, and responding well to treatment with non-steroidal anti-inflammatory drugs and colchicine 3, 5.

Diagnosis and Treatment

• Diagnosis of pericarditis post-vaccination involves a standardized workup, including serum troponin measurement, polymerase chain reaction testing for COVID-19 infection, routine additional lab work, and a 12-lead electrocardiogram 3.
• Echocardiography is recommended as the imaging modality of choice for patients with unexplained troponin elevation and/or pathologic electrocardiogram changes 3.
• Treatment is largely supportive, with non-steroidal anti-inflammatory drugs and colchicine being used to manage symptoms, and corticosteroids reserved for refractory cases 5, 6.

Risk-Benefit Analysis

• The benefits of COVID-19 vaccination currently outweigh the side effect profile, and vaccination is recommended as the first-line approach to control the pandemic 2, 5.
• The incidence of myocarditis and pericarditis following COVID-19 vaccination is extremely low, ranging from 2-20 per 100,000, and is lower than the risk of these conditions following COVID-19 infection 5.
• The risk of pericarditis post-vaccination must be viewed in context with the millions of patients who have been safely vaccinated and the known morbidity and mortality from COVID-19 infection 4.