Myocarditis, Pulmonary Hemorrhage, and Extensive Myositis with Rhabdomyolysis 12 Days After First Dose of Pfizer-BioNTech BNT162b2 mRNA COVID-19 Vaccine: A Case Report

"Abstract

Background: The COVID-19 pandemic is a current global crisis, and there are hundreds of millions of individuals being vaccinated worldwide. At present, there have been few reports of COVID-19 vaccine-induced autoimmune processes manifested as myositis, thrombocytopenia, and myocarditis.

Case Report: A 37-year-old man presented to the Emergency Department (ED) with a 3-day history of back pain and a 1-day history of left upper limb swelling with paresthesia and shortness of breath, 12-days after receiving the first dose of Pfizer/BioNTech BNT162b2 mRNA COVID-19 vaccine...

Discussion 

... Our patient had an extensive myositis complicated with rhabdomyolysis, which could have been due to muscle injury at the injection site that led to the host’s inflammatory response against the intramuscular vaccination, causing severe muscle toxicity and thus releasing high CK levels... 

The patient also had myocarditis, which was evident by pulmonary edema, raised troponin and pro-BNP [pro B-type natriuretic peptide] levels, and reduced left ventricular systolic function on echocardiogram...

This case describes a possible link between BNT162b2 mRNA COVID-19 (Pfizer-BioNTech) vaccine and ADRs [adverse drug reactions] manifested by thrombocytopenia, alveolar hemorrhage, myocarditis, and myositis complicated with rhabdomyolysis and non-oliguric acute kidney injury after we excluded all other causes of the patient presentation. In view of the proposed immune-mediated effect of the presented complications, the patient was managed with IVIG and steroids, which resulted in significant improvement in his clinical condition through the course of admission."