Autopsy-based histopathological characterization of myocarditis after anti-SARS-CoV-2-vaccination

Clin Res Cardiol. 2023 Mar;112(3):431-440. doi: 10.1007/s00392-022-02129-5. Epub 2022 Nov 27.

Abstract

Cases of myocarditis, diagnosed clinically by laboratory tests and imaging have been described in the context of mRNA-based anti-SARS-CoV-2 vaccination. Autopsy-based description of detailed histological features of vaccine-induced myocarditis is lacking. We describe the autopsy findings and common characteristics of myocarditis in untreated persons who received anti-SARS-CoV-2 vaccination. Standardized autopsies were performed on 25 persons who had died unexpectedly and within 20 days after anti-SARS-CoV-2 vaccination. In four patients who received a mRNA vaccination, we identified acute (epi-)myocarditis without detection of another significant disease or health constellation that may have caused an unexpected death. Histology showed patchy interstitial myocardial T-lymphocytic infiltration, predominantly of the CD4 positive subset, associated with mild myocyte damage. Overall, autopsy findings indicated death due to acute arrhythmogenic cardiac failure. Thus, myocarditis can be a potentially lethal complication following mRNA-based anti-SARS-CoV-2 vaccination. Our findings may aid in adequately diagnosing unclear cases after vaccination and in establishing a timely diagnosis in vivo, thus, providing the framework for adequate monitoring and early treatment of severe clinical cases.

Keywords: Autopsy; Cardiac pathology; Myocarditis; SARS; Vaccination.

MeSH terms

  • Autopsy
  • COVID-19* / diagnosis
  • COVID-19* / prevention & control
  • Heart Failure*
  • Humans
  • Myocarditis* / diagnosis
  • Myocarditis* / etiology
  • RNA, Messenger
  • Vaccination

Substances

  • RNA, Messenger