Discussion:
Because of the most of the myopericarditis are asymptomatic, the incidence and prevalence of this disease is not known exactly. But it is suspected to be in the range of 1-10 cases per 100.000 persons and had a variable autopsy prevalence(2–42%). The causes of myocarditis include infectious and autoimmune etiologies(4).
In literatüre review in myocarditis cases after COVID-19 vaccination, nearly all of them had high TI, most of them had abnormal ECG. Only a half of them had abnormal echocardiographic findings. There were late gadolinium enhancement and myocardial edema on cardiac MRI as a suggestion for myocarditis on patients(1).
Although myopericarditis can be seen in the current immunization process after many vaccines(3).
In recent studies, presented patients were male and aged between 14-19 years-old. All of the myopericarditis occured after second dose of vaccine. And approximately 60% of myocarditis developed especially after the Pfizer-BioNTech mRNA vaccine (5).
The mechanism of the COVID-19 vaccine associated myocarditis can be due to cross-reaction between the antibodies against SARS-CoV-2 spike glycoproteins and α-myosin(6).
CMR became the primary non-invasive test to assess the myocardial inflammation in patients with suspected myocarditis (7).
SE is a technique of echocardiograhy which allows assessing left ventricular contractility better than TE, especially in individuals with normal systolic functions (8).
CMR and SE have been compared in the diagnosis and follow-up of myocarditis in several studies, these studies presented the inflammation detection as wall motion abnormalities are correlated between the SE and CMR (9). According with this data, although CMR had a certain place for the diagnosis and follow-up of myocarditis, we think that SE is an effective method to diagnose and follow these patients in case of CMR cannot accessible.
As in our case, Beata et al. prensented that myocarditis can successfully diagnosed with SE(10). In our patient, similar data with CMR and SE were obtained and these values ​​ in SE improved before discharge. While it is a more practical and cost-effective on follow-up with SE than CMR , also SE can be used for accuracy of diagnosis in cases where CMR is not available.
Management of these patients vary due to the patient’s age as similiar with non-vaccine myopericarditis; clinical presentation-comorbidities-hemodynamic stability are importent for patients’ management, Nonsteroidal anti-inflammators(NSAI), steroids, colchicine are the main treatments .beta-blockers and renin-angiotensin-aldosterone system inhibitors can use(6).