Abstract
Myocarditis induced by diphtheria–tetanus–pertussis (DTP) vaccination is extremely
rare, accounting for only two cases thus far. Hence, to supplement knowledge regarding
its pathogenesis and treatment, we reported two cases of myocarditis associated with
DTP vaccination in adults. Two patients (a 40-year-old female and a 43-year-old male)
presented with mild symptoms and were hemodynamically stable. In both patients, the
DTP vaccination was given 4 and 6 days before admission. Both patients had prolonged
corrected QT interval (QTc), poor left ventricular function, and high troponin levels
at admission. However, numerous ST segment depression was only noted in the first
case. Bacteriology and virology study results were negative for any pathogen. No atherosclerotic
lesions were observed by coronary angiography. Cardiac magnetic resonance imaging
was only performed in the second case, which confirmed the diagnosis of myocarditis.
Initial therapy was administered with a beta-blocker, angiotensin-converting enzyme
inhibitor, and intravenous methylprednisolone. Nonetheless, in the first case, rapid
clinical deterioration and sudden cardiac death occur within 3 days of hospitalization.
Learn from the first case, a high-dose intravenous immunoglobulin (IVIG) treatment
was initiated in the second case, which resulted in an improvement in left ventricular
function and clinical symptoms, as well as a significant reduction in QTc interval
and troponin levels. Rapid diagnostic testing and early recognition of the fulminant
course is mandatory, allowing clinicians to aggressively treat the patient with high-dose
intravenous immune globulin, thus obtaining a better outcome.
Keywords
myocarditis - vaccination - autoimmune
