A rare case of atypical endocarditis occurring aftercomirnaty vaccine

ABSTRACT

Background: According to Centers for Disease Control and Prevention (CDC) and Food and Drug Administration (FDA) data, from January 2021 six cases of endocarditis associated to Pfizer BioNTech Covid Vaccine were reported. Case description On December 2021 S.A., female, 42 years old, with no history of previous diseases, was admitted with a history of left hemifacial hypoaesthesia, left hand hypostenia and transient blindess occurring 72 hrs after the 2nd dose of Comirnaty vaccine, followed by right lower limb hypoaesthesia and hypostenia 48 hrs after the 3rd dose, with subsequent onset of chills, arthromyalgias and fever. Brain DWI-MRI showed T2 hyperintense subcortical lesions;a vegetation on mitral valve posterior leaflet and on aortic valve anterior leaflet were recorded by heart ultrasound. Empyrical antibiotics were used for fever after performing multiple hemocoltures, that resulted negative. Autoimmune tests were negative. At day 20, the patient underwent successful transcatheter aortic valve implantation (TAVI). The macroscopic aspect of the valve was not compatible with bacterial vegetations, and its colture showed rare colonies of P. aeruginosa. Conclusions: This is the 7th case of endocarditis potentially related to Comirnaty vaccine, with subsequent infection. The timing of symptoms, the atypical vegetations, patient's characteristics (sex, age) the negative autoimmunity tests are consistent with our hypothesis. Further data and a proper continuation of epidemiological monitoring worldwide will be essential for confirmation.