Introduction:

Acute pericarditis is an inflammatory disease of the pericardium with less than three months of evolution, which diagnosis is based essentially on the physical examination, in the presence of symptoms, electrocardiographic and analytic changes (elevation of cardiac troponin). In December 2020, the Pfizer-BioNTech COVID-19 vaccine was authorized and on June 23rd of 2021, a “probable association” was found between the Pfizer-BioNTech and Moderna COVID-19 vaccines and the appearance of myocarditis and/or pericarditis in some young adults, by the Safety Committee of the US Centers for Disease Control and Prevention.

Case description:

A 69-year-old male patient was vaccinated on May 3rd of 2021 with the Pfizer-BioNTech COVID-19 vaccine. Approximately twelve hours later, he started with pain in the left hemithorax and mild dyspnea. Four days after taking the vaccine, he developed a fever, associated with mild dyspnea and pain in the left hemithorax, with irradiation to the left clavicle region. In the emergency department, seven days after the onset of symptoms, based on clinical history, increased inflammatory markers, and evidence of pericardial effusion identified on cardiac computed tomography, probable acute pericarditis was diagnosed.

Comments:

Although causality cannot be confirmed, the temporal correlation with taking the Pfizer-BioNTech COVID-19 vaccine, as well as the biological plausibility of an autoimmune response or a cross-reaction due to molecular mimicry, support the suspicion that an adverse reaction has occurred. Despite the fact that the recommendations for these cases are still evolving, currently, according to guidance from the National Advisory Committee on Immunization of Canada, it may be prudent to delay the second dose of the vaccine.

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