Autopsy-based histopathological characterization of myocarditis after anti-SARS-CoV-2-vaccination
Published: 27 November 2022
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. Here, we describe the cardiac autopsy findings in five persons who have died unexpectedly within seven days following anti-SARS-CoV-2-vaccination, with vaccine-induced myocardial inflammation representing the likely or possible cause of death. Our findings establish the histological phenotype of lethal vaccination-associated myocarditis.
Results
Among the 35 cases of the University of Heidelberg, autopsies revealed other causes of death (due to pre-existing illnesses) in 10 patients (Supplementary Table 1). Hence, these were excluded from further analysis.
Cardiac autopsy findings consistent with (epi-)myocarditis were found in five cases of the remaining 25 bodies found unexpectedly dead at home within 20 days following SARS-CoV-2 vaccination.Clinical findings, blood tests, ECGs or imaging data were not available as deceased persons did not seek medical attention prior to death. Person 1 was found dead 12 h after the vaccination. A witness described a rattling breath shortly before discovering circulatory failure. Person 2 complained about nausea and was found dead soon thereafter. Resuscitation was started immediately but without success, respectively. The other persons were found dead at home without available information about terminal symptoms.
According to the available information provided at the time of autopsies, none of the deceased persons had SARS-CoV-2 infection prior to vaccination and nasopharyngeal swabs were negative in all cases.All cases lacked significant coronary heart disease, acute or chronic manifestations of ischaemic heart disease, manifestations of cardiomyopathy or other signs of a pre-existing, clinically relevant heart disease.Through our autopsy-based approach, we identified five cases of lymphocytic (epi-)myocarditis in persons, who were unexpectedly found dead at home within the first week following mRNA-mediated anti-SARS-CoV-2 immunization
In general, a causal link between myocarditis and anti-SARS-CoV-2 vaccination is supported by several considerations: (A) a close temporal relation to vaccination; all cases were found dead within one week after vaccination, (B) absence of any other significant pre-existing heart disease, especially ischaemic heart disease or cardiomyopathy, (C) negative testing for potential myocarditis-causing infectious agents, (D) presence of a peculiar CD4 predominant T-cell infiltrate, suggesting an immune mediated mechanism.
Based on the autopsy findings and all available data, no other cause of death except (epi-)myocarditis was identified in any of the cases presented here.
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https://link.springer.com/article/10.1007/s00392-022-02129-5