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Incidence of Myocarditis Associated with Diphtheria, Tetanus, and Pertussis Vaccine: A Rare Case SeriesFunding None
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.
This study was approved by the Medical Research Ethics Committee of Dr Hasan Sadikin Central General Hospital, West Java, Indonesia.
Informed consent was obtained from the patients for being included in the case series.
Data are available on reasonable request
Article published online:
29 March 2023
© 2023. International College of Angiology. This article is published by Thieme.
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- 1 Tschöpe C, Ammirati E, Bozkurt B. et al. Myocarditis and inflammatory cardiomyopathy: current evidence and future directions. Nat Rev Cardiol 2021; 18 (03) 169-193
- 2 Boccara F, Benhaiem-Sigaux N, Cohen A. Acute myopericarditis after diphtheria, tetanus, and polio vaccination. Chest 2001; 120 (02) 671-672
- 3 Wu SJ, Sun S, Li JY, Hu PY, Chien CY. Acute fulminant myocarditis after diphtheria, polio, and tetanus vaccination. Asian Cardiovasc Thorac Ann 2006; 14 (06) e111-e112
- 4 Caforio ALP, Pankuweit S, Arbustini E. et al; European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J 2013; 34 (33) 2636-2648 , 2648a–2648d
- 5 Schouten EG, Dekker JM, Meppelink P, Kok FJ, Vandenbroucke JP, Pool J. QT interval prolongation predicts cardiovascular mortality in an apparently healthy population. Circulation 1991; 84 (04) 1516-1523
- 6 Hung Y, Lin WH, Lin CS. et al. The prognostic role of QTc interval in acute myocarditis. Zhonghua Minguo Xinzangxue Hui Zazhi 2016; 32 (02) 223-230
- 7 Lee CH, Tsai WC, Hsu CH, Liu PY, Lin LJ, Chen JH. Predictive factors of a fulminant course in acute myocarditis. Int J Cardiol 2006; 109 (01) 142-145
- 8 Wang Z, Wang Y, Lin H, Wang S, Cai X, Gao D. Early characteristics of fulminant myocarditis vs non-fulminant myocarditis: a meta-analysis. Medicine (Baltimore) 2019; 98 (08) e14697
- 9 Watad A, Quaresma M, Brown S. et al. Autoimmune/inflammatory syndrome induced by adjuvants (Shoenfeld's syndrome)—an update. Lupus 2017; 26 (07) 675-681
- 10 Huang X, Sun Y, Su G, Li Y, Shuai X. Intravenous immunoglobulin therapy for acute myocarditis in children and adults. Int Heart J 2019; 60 (02) 359-365