Summary of Diagnostics and Therapeutics: 7 Cases of Symptomatic Myocarditis After Dose 2 of Pfizer-BioNTech COVID-19 Vaccine

Patient 1Patient 2Patient 3Patient 4Patient 5Patient 6Patient 7
Laboratory findings on admission
 Troponin (normal range), ng/mLTroponin I: 2.59 (<0.03)High-sensitivity troponin T: 232 (<14)Troponin I: 5.55 (<0.045)Troponin T:1.09 (<0.01)Troponin T: 3.2 (<0.01)Troponin T: 0.66 (<0.01)Troponin I: 22.1 (<0.045)
 Brain natriuretic peptide (normal < 100), pg/mL107.9
 NT-proBNP (normal <125), pg/mL428376978149
 Peripheral white blood cell count, thousands of cells per mm36.978.6911.812.616.35.08.11
 Absolute lymphocyte count, thousands of cells per mm31.691.392.
 Absolute neutrophil count, thousands of cells per mm34.655.937.469.
 Platelet count, thousands of cells per mm3198208231236297189208
 Albumin (g/dL)
 Aspartate transaminase, U/L542941821505987
 Alanine transaminase, U/L30143320462238
 Ferritin, ug/L70901033476584
 CRP (normal <1.0), mg/dL0.996.72.512.718.11.57.7
 ESR, mm/h181364038310
 Prothrombin time, seconds14.012.111.414.8
 Partial thromboplastin time, seconds22.331.430.427.935.6
 International normalized ratio INR1.
Other pertinent laboratory findings
 Highest troponin (normal range), ng/mLTroponin I: 12.43 (<0.80)High-sensitivity troponin T: 388 (<14)Troponin I: 12.20 (<0.045)Troponin T: 1.09 (<0.01)Troponin T: 3.33 (<0.01)Troponin T: 0.82 (<0.01)Troponin I: 22.1 (<0.045)
 Lowest troponin before discharge (normal range), ng/mLTroponin I: 1.42(<0.80)Troponin I: 5.79 (<0.045)Troponin T: 0.4 (<0.01)Troponin T: 0.96 (<0.01)Troponin T: 0.01 (<0.01)Troponin I: 8.02 (<0.045)
 Highest BNP (normal range), pg/mL205(<100)
 Highest NT-proBNP (normal range)482 pg/mL (<125)376 pg/mL (<300)978 pg/mL (<125)275 pg/mL (<125)
 Highest CRP (normal <1.0), mg/dL1.236.72.5312.718.11.812.7
 COVID-19 PCR resultNegativeNegativeNegativeNegativeNegativeNegativeNegative
 COVID-19 spike antibody (manufacturer)Positive (Roche)Positive (Roche)Positive (Roche)Positive (Roche)
 COVID-19 nucleocapsid antibody result (manufacturer)Negative (Abbott)Negative (Roche)Negative (Roche)Negative (Roche)Negative (Roche)Negative (Abbott)
 Respiratory pathogen panel PCR resulta (manufacturer)Negative (BioFire)Negative (BioFire)Negative (BioFire)Negative (BioFire)Negative (BioFire)Negative (BioFire)Negative (BioFire)
 Adenovirus diagnostics resultNegative serum PCRNegative serologyNegative serum PCRNegative serum PCRNegative serum PCR
 Enterovirus diagnostics resultNegative serum PCRNegative serologyNegative serum PCRNegative serum PCRNegative serum PCRNegative serum PCR
 Cytomegalovirus diagnostics resultNegative serum PCRNegative serologyNegative serum PCRNegative serum PCRNegative serum PCRNegative serology
 Epstein-Barr virus diagnostics resultNegative serologyNegative serum PCRNegative serum PCRNegative IgM, positive IgG antibodyNegative serology
 Other diagnosticsNegative parvovirus, bartonella, and Lyme serology, negative urine drug screenNegative parvovirus and bartonella serology, negative HHV-6 serum PCRNegative Lyme serology, negative mycoplasma serum PCR, negative parvovirus serum PCRNegative parvovirus IgM, positive parvovirus IgG antibody, negative mycoplasma PCR (throat swab)
Diagnostic imaging findings
 Cardiac MRILGE (subepicardial) involving lateral LV apex, myocardial edema of lateral LV wall, left axillary adenopathyLGE involving mid LV wall, myocardial edema of basal inferolateral LV wallLGE (subepicardial) involving basal anterolateral and basal to midventricular inferolateral LV segments, myocardial edema, elevated extracellular volume fraction (29.2%)Fibrosis, myocardial edema, hyperemia, mild mitral regurgitation (RF ∼18%)LGE (epicardial) involving anterior and lateral LV wall, no myocardial edemaLGE, diffuse myocardial edemaLGE (subepicardial) involving mid and apical LV free wall, myocardial edema, hyperemia
 EchocardiogramNormalNormalBorderline basal lateral and basal posterior strainNormalNormalNormalMildly depressed RV and LV systolic function (LVEF 47%)
 ECGAtrioventricular dissociation with junctional escape rhythm, ST elevationST segment elevation (diffuse)ST elevation (diffuse), T-wave abnormalityST elevationSinus bradycardia, T-wave abnormalityST elevation (diffuse)ST elevation, low voltage of extremity leads
 Oxygen supplementationNoneNoneNoneNoneNoneNoneLFNC
 Vasoactive medications or inotropic supportNoneNoneNoneNoneNoneNoneNone
 Antiinflammatory agents and other relevant medicationsNSAID, IVIg, IV methylprednisolone, PO prednisone, famotidineNSAID, colchicine, aspirinNSAID, famotidineNSAID, IVIg, IV methylprednisolone, PO prednisoneNSAID, IVIg, IV methylprednisolone, PO prednisone, aspirinIVIg, PO prednisoneNSAID, famotidine, furosemide
  • HHV-6, human herpesvirus-6; IgG, immunoglobulin G; IgM, immunoglobulin M; INR, international normalized ratio; IV, intravenous; LGE, late gadolinium enhancement; LFNC, low flow nasal cannula; LV, left ventricular; LVEF, left ventricular ejection fraction; PO, per os (oral); q12hr, every 12 hours; RF, regurgitant fraction; RV, right ventricular; —, not done.

  • a BioFire Respiratory Panel includes PCR for adenovirus, coronavirus 229E, coronavirus HKU1, coronavirus NL63, coronavirus OC43, metapneumovirus (human), rhinovirus or enterovirus, influenza A, influenza B, parainfluenza 1, parainfluenza 2, parainfluenza 3, parainfluenza 4, respiratory syncytial virus, Bordetella parapertussis, Bordetella pertussis, Chlamydophila pneumonia, and Myocoplasma pneumonia.