{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T07:58:43Z","timestamp":1775721523216,"version":"3.50.1"},"reference-count":20,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T00:00:00Z","timestamp":1773360000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T00:00:00Z","timestamp":1775692800000},"content-version":"vor","delay-in-days":27,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100003793","name":"Hj\u00e4rt-Lungfonden","doi-asserted-by":"publisher","award":["H556916013"],"award-info":[{"award-number":["H556916013"]}],"id":[{"id":"10.13039\/501100003793","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004047","name":"Karolinska Institute","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100004047","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Med Case Reports"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Despite the reporting of myocarditis associated with coronavirus disease 2019 vaccination, the correlation between vaccine-related rhabdomyositis and myocarditis incidence remains undocumented. This case offers a new perspective on myocarditis, potentially associated with the coronavirus disease 2019 vaccine, possibly caused by the strong immunostimulatory effects of messenger RNA vaccination-related rhabdomyositis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A 25-year-old male athlete of Swedish (white) ethnicity and non-Hispanic origin collapsed during a strenuous ice hockey training session after receiving his third dose of the coronavirus disease 2019 vaccine (BN162b2). He had received standard cardiopulmonary resuscitation, and the electrocardiography showed ventricle fibrillation. According to the laboratory test, elevations were observed in troponin T, aminotransferase, blood glucose, and leucocyte number. Magnetic resonance imaging indicated disseminated myocarditis. A biopsy of the heart revealed mild lymphocytic inflammation and focal myocytolysis. The patient had permanent brain damage and passed away after the breathing tube was removed. The autopsy revealed cardiac muscle necrosis and skeletal muscle rhabdomyolysis. There was a sign of massive expansion of lymphoid compartment in the gastrointestinal tract. Increased hemophagocytosis and eosinophils were seen in the lymph node and bone marrow. The specific case drew attention to a potential association between the coronavirus disease 2019 vaccine and fatal myocarditis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>We suggest that strenuous training associated with skeletal muscle damage, together with the strong immunostimulatory effect of messenger RNA vaccination, may lead to autoimmune rhabdomyositis that potentially cross-reacts with the myocardium. Athletes should be aware of the potential danger of heavy training in close proximity to vaccination or acute infections.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13256-026-05948-6","type":"journal-article","created":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T14:06:30Z","timestamp":1773410790000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Acute myocarditis and rhabdomyositis after coronavirus disease 2019 messenger RNA vaccination and intensive training: a case report"],"prefix":"10.1186","volume":"20","author":[{"given":"Jieyu","family":"Wu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Attila","family":"Szakos","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bela","family":"Bozoky","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6144-6573","authenticated-orcid":false,"given":"Laszlo","family":"Szekely","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,3,13]]},"reference":[{"key":"5948_CR1","doi-asserted-by":"publisher","first-page":"2851","DOI":"10.1097\/JS9.0000000000000513","volume":"109","author":"R Sarker","year":"2023","unstructured":"Sarker R, Roknuzzaman ASM, Hossain MJ, Bhuiyan MA, Islam MR. The WHO declares COVID-19 is no longer a public health emergency of international concern: benefits, challenges, and necessary precautions to come back to normal life. Int J Surg. 2023;109:2851\u20132.","journal-title":"Int J Surg"},{"key":"5948_CR2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2021-005427","author":"M Michelen","year":"2021","unstructured":"Michelen M, Lakshmi M, Elkheir N, Cheng V, Dagens A, Hastie C, Hara MO, Suett J, Dahmash D, Bugaeva P, et\u00a0al. Characterising long COVID: a living systematic review. BMJ Glob Health. 2021. https:\/\/doi.org\/10.1136\/bmjgh-2021-005427.","journal-title":"BMJ Glob Health"},{"key":"5948_CR3","doi-asserted-by":"publisher","first-page":"600","DOI":"10.1001\/jamacardio.2022.0583","volume":"7","author":"K \u00d8","year":"2022","unstructured":"\u00d8 K, Hovi P, Husby A, H\u00e4rk\u00e4nen T, Selmer R, Pihlstr\u00f6m N, Hansen JV, Nohynek H, Gunnes N, Sundstr\u00f6m A, et\u00a0al. SARS-CoV-2 vaccination and myocarditis in a Nordic cohort study of 23 million residents. JAMA Cardiol. 2022;7:600\u201312.","journal-title":"JAMA Cardiol"},{"key":"5948_CR4","doi-asserted-by":"publisher","first-page":"1210","DOI":"10.1001\/jama.2021.13443","volume":"326","author":"GA Diaz","year":"2021","unstructured":"Diaz GA, Parsons GT, Gering SK, Meier AR, Hutchinson IV, Robicsek A. Myocarditis and pericarditis after vaccination for COVID-19. JAMA. 2021;326:1210\u20132.","journal-title":"JAMA"},{"key":"5948_CR5","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2022.1007637","volume":"10","author":"Y Ding","year":"2022","unstructured":"Ding Y, Ge Y. Inflammatory myopathy following coronavirus disease 2019 vaccination: a systematic review. Front Public Health. 2022;10: 1007637.","journal-title":"Front Public Health"},{"key":"5948_CR6","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2022.951314","author":"V Navya","year":"2022","unstructured":"Navya V, Reddy S, Ssentongo P. Myocarditis in SARS-CoV-2 infection vs. COVID-19 vaccination: a systematic review and meta-analysis. Front Cardiovasc Med. 2022. https:\/\/doi.org\/10.3389\/fcvm.2022.951314.","journal-title":"Front Cardiovasc Med"},{"key":"5948_CR7","doi-asserted-by":"publisher","first-page":"471","DOI":"10.1161\/CIRCULATIONAHA.121.056135","volume":"144","author":"B Bozkurt","year":"2021","unstructured":"Bozkurt B, Kamat I, Hotez P. Myocarditis with COVID-19 mRNA vaccines. Circulation. 2021;144:471\u201384.","journal-title":"Circulation"},{"key":"5948_CR8","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2021-069445","volume":"378","author":"J Pillay","year":"2022","unstructured":"Pillay J, Gaudet L, Wingert A, Bialy L, Mackie AS, Paterson DI, Hartling L. Incidence, risk factors, natural history, and hypothesised mechanisms of myocarditis and pericarditis following covid-19 vaccination: living evidence syntheses and review. BMJ. 2022;378: e069445.","journal-title":"BMJ"},{"key":"5948_CR9","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1016\/j.pcad.2022.10.004","volume":"74","author":"A Rout","year":"2022","unstructured":"Rout A, Suri S, Vorla M, Kalra DK. Myocarditis associated with COVID-19 and its vaccines - A systematic review. Prog Cardiovasc Dis. 2022;74:111\u201321.","journal-title":"Prog Cardiovasc Dis"},{"key":"5948_CR10","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2022.884776","volume":"13","author":"Y Nakagomi","year":"2022","unstructured":"Nakagomi Y, Tajiri K, Shimada S, Li S, Inoue K, Murakata Y, Murata M, Sakai S, Sato K, Ieda M. Immune checkpoint inhibitor-related myositis overlapping with myocarditis: an institutional case series and a systematic review of literature. Front Pharmacol. 2022;13: 884776.","journal-title":"Front Pharmacol"},{"key":"5948_CR11","doi-asserted-by":"publisher","first-page":"811","DOI":"10.1016\/j.autrev.2017.05.021","volume":"16","author":"C Comarmond","year":"2017","unstructured":"Comarmond C, Cacoub P. Myocarditis in auto-immune or auto-inflammatory diseases. Autoimmun Rev. 2017;16:811\u20136.","journal-title":"Autoimmun Rev"},{"key":"5948_CR12","first-page":"302","volume":"39","author":"P Oflazer","year":"2020","unstructured":"Oflazer P. Giant cell myositis and myocarditis revisited. Acta Myol. 2020;39:302\u20136.","journal-title":"Acta Myol"},{"key":"5948_CR13","first-page":"1","volume":"4","author":"A Shabbir","year":"2020","unstructured":"Shabbir A, Camm CF, Elkington A, Tilling L, Stirrup J, Chan A, Bull S. Myopericarditis and myositis in a patient with COVID-19: a case report. Eur Heart J. 2020;4:1\u20136.","journal-title":"Eur Heart J"},{"key":"5948_CR14","doi-asserted-by":"publisher","first-page":"1485","DOI":"10.1161\/CIRCULATIONAHA.125.074644","volume":"152","author":"S Fanti","year":"2025","unstructured":"Fanti S, Dyer C, Ingimarsdottir IJ, Harding D, Wang G, D\u2019Amati A, Shahaj E, Sigurbergsdottir AY, Thorsdottir H, Gunnarsdottir OB, et\u00a0al. Combined adaptive immune mechanisms mediate cardiac injury after COVID-19 vaccination. Circulation. 2025;152:1485\u2013500.","journal-title":"Circulation"},{"key":"5948_CR15","doi-asserted-by":"publisher","DOI":"10.1186\/s12967-016-1111-6","volume":"15","author":"DK Edwards","year":"2017","unstructured":"Edwards DK, Jasny E, Yoon H, Horscroft N, Schanen B, Geter T, Fotin-Mleczek M, Petsch B, Wittman V. Adjuvant effects of a sequence-engineered mRNA vaccine: translational profiling demonstrates similar human and murine innate response. J Transl Med. 2017;15: 1.","journal-title":"J Transl Med"},{"key":"5948_CR16","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1016\/j.molmed.2019.10.002","volume":"26","author":"S Linares-Fern\u00e1ndez","year":"2020","unstructured":"Linares-Fern\u00e1ndez S, Lacroix C, Exposito J-Y, Verrier B. Tailoring mRNA vaccine to balance innate\/adaptive immune response. Trends Mol Med. 2020;26:311\u201323.","journal-title":"Trends Mol Med"},{"key":"5948_CR17","doi-asserted-by":"publisher","DOI":"10.3390\/biomedicines11020451","author":"P Bellavite","year":"2023","unstructured":"Bellavite P, Ferraresi A, Isidoro C. Immune response and molecular mechanisms of cardiovascular adverse effects of spike proteins from SARS-CoV-2 and mRNA vaccines. Biomedicines. 2023. https:\/\/doi.org\/10.3390\/biomedicines11020451.","journal-title":"Biomedicines"},{"key":"5948_CR18","doi-asserted-by":"publisher","DOI":"10.1055\/a-2326-5815","author":"C Tasg\u00f6z","year":"2024","unstructured":"Tasg\u00f6z C, Acar EA, S\u00fcl\u00fckc\u00fc S, Uslu S, G\u00fcnd\u00fcz OS. Reactive arthritis following COVID-19 vaccination: report of three cases. Aktuelle Rheumatol. 2024. https:\/\/doi.org\/10.1055\/a-2326-5815.","journal-title":"Aktuelle Rheumatol"},{"key":"5948_CR19","doi-asserted-by":"publisher","first-page":"314","DOI":"10.1016\/j.jacc.2020.11.031","volume":"77","author":"R Kawakami","year":"2021","unstructured":"Kawakami R, Sakamoto A, Kawai K, Gianatti A, Pellegrini D, Nasr A, Kutys B, Guo L, Cornelissen A, Mori M, et\u00a0al. Pathological evidence for SARS-CoV-2 as a cause of myocarditis: JACC\u00a0review\u00a0topic\u00a0of\u00a0the\u00a0week. J Am Coll Cardiol. 2021;77:314\u201325.","journal-title":"J Am Coll Cardiol"},{"key":"5948_CR20","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics12112789","author":"A Razaghi","year":"2022","unstructured":"Razaghi A, Szakos A, Alouda M, Bozoky B, Bjornstedt M, Szekely L. Proteomic analysis of pleural effusions from COVID-19 deceased patients: enhanced inflammatory markers. Diagnostics. 2022. https:\/\/doi.org\/10.3390\/diagnostics12112789.","journal-title":"Diagnostics"}],"container-title":["Journal of Medical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13256-026-05948-6","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13256-026-05948-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13256-026-05948-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T07:21:22Z","timestamp":1775719282000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s13256-026-05948-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,13]]},"references-count":20,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["5948"],"URL":"https:\/\/doi.org\/10.1186\/s13256-026-05948-6","relation":{},"ISSN":["1752-1947"],"issn-type":[{"value":"1752-1947","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,13]]},"assertion":[{"value":"12 November 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 January 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 March 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The project was approved by the regional ethical authority in Stockholm, Sweden (DNR 2022-02446, DNR 202-04339, and DNR 202100-2973). The next-of-kin consented to organ donation, subsequent autopsy, and scientific analysis of the sampled material.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent was obtained from the patient\u2019s next-of-kin for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"All authors claim no conflicts of interest related to this work.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"175"}}