{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:50:24Z","timestamp":1787028624203,"version":"build-2736575974"},"reference-count":8,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2022,3,16]],"date-time":"2022-03-16T00:00:00Z","timestamp":1647388800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"r","award":["Italian Ministry of Health \u201cRicerca corrente  IRCCS Spallanzani"],"award-info":[{"award-number":["Italian Ministry of Health \u201cRicerca corrente  IRCCS Spallanzani"]}]},{"name":"Project COVID","award":["2020 12371675"],"award-info":[{"award-number":["2020 12371675"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Myocarditis, even in a severe and lethal form, may occur after COVID-19 mRNA (BNT162b2) vaccination. However, its pathway, morphomolecular characterization and treatment are still unknown. Methods: Routine hematochemical screening, ECG, Holter monitoring, 2D echocardiogram cardiac magnetic resonance (CMR) and invasive cardiac studies (cardiac catheterization, selective coronary angiography, left ventriculography and left ventricular endomyocardial biopsy) are reported from three patients (39F-pt1, 78M-pt2, 52M-pt3) with severe compromise of conduction tissue (junctional rhythm and syncope, pt1) or cardiac function compromise (LVEF \u2264 35%, pt2 and pt3) after COVID-19 mRNA (BNT162b2). Results: Hematochemical data and coronary angiography were normal in the patients studied. Histology showed in all three patients extensive myocardial infiltration of degranulated eosinophils and elevation of serum cationic protein directly responsible for cardiomyocyte damage. These findings demonstrate myocarditis hypersensitivity to some component of the vaccine (spike protein?) acting as a hapten to some macromolecules of cardiomyocytes. Steroid administration (prednisone, 1 mg\/kg die for 3 days, followed by 0.33 mg\/kg for 4 weeks) was followed by complete recovery of cardiac contractility in pt2 and pt3. Conclusions: Eosinophilic myocarditis is a possible adverse reaction to the mRNA COVID-19 vaccine. Its pathway is mediated by release of cationic protein and responds to short courses of steroid administration.<\/jats:p>","DOI":"10.3390\/jcm11061660","type":"journal-article","created":{"date-parts":[[2022,3,16]],"date-time":"2022-03-16T22:09:58Z","timestamp":1647468598000},"page":"1660","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Hypersensitivity Myocarditis after COVID-19 mRNA Vaccination"],"prefix":"10.3390","volume":"11","author":[{"given":"Andrea","family":"Frustaci","sequence":"first","affiliation":[{"name":"Department of Clinical, Internal, Anesthesiologist and Cardiovascular Sciences, La Sapienza University, 00161 Rome, Italy"},{"name":"Cellular and Molecular Cardiology Lab, IRCCS L. Spallanzani, 00149 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Romina","family":"Verardo","sequence":"additional","affiliation":[{"name":"Cellular and Molecular Cardiology Lab, IRCCS L. Spallanzani, 00149 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4708-5120","authenticated-orcid":false,"given":"Nicola","family":"Galea","sequence":"additional","affiliation":[{"name":"Department of Experimental Medicine, Sapienza University, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo","family":"Lavalle","sequence":"additional","affiliation":[{"name":"Department of DAI Cardio-Thoraco-Vascular and Organ Transplant Surgery, La Sapienza University, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4727-889X","authenticated-orcid":false,"given":"Giulia","family":"Bagnato","sequence":"additional","affiliation":[{"name":"Cellular and Molecular Cardiology Lab, IRCCS L. Spallanzani, 00149 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2237-9125","authenticated-orcid":false,"given":"Rossella","family":"Scialla","sequence":"additional","affiliation":[{"name":"Cellular and Molecular Cardiology Lab, IRCCS L. Spallanzani, 00149 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Chimenti","sequence":"additional","affiliation":[{"name":"Department of Clinical, Internal, Anesthesiologist and Cardiovascular Sciences, La Sapienza University, 00161 Rome, Italy"},{"name":"Cellular and Molecular Cardiology Lab, IRCCS L. Spallanzani, 00149 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,3,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2140","DOI":"10.1056\/NEJMoa2109730","article-title":"Myocarditis after BNT162b2 mRNA Vaccine against Covid-19 in Israel","volume":"385","author":"Mevorach","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e068665","DOI":"10.1136\/bmj-2021-068665","article-title":"SARS-CoV-2 vaccination and myocarditis or myopericarditis: Population based cohort study","volume":"375","author":"Husby","year":"2021","journal-title":"BMJ"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1332","DOI":"10.1056\/NEJMc2109975","article-title":"Myocarditis after Covid-19 mRNA Vaccination","volume":"385","author":"Verma","year":"2021","journal-title":"N. Engl. J. 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Heart J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"3534","DOI":"10.1161\/01.CIR.0000148823.08092.0E","article-title":"Intramyocyte Detection of Epstein-Barr Virus Genome by Laser Capture Microdissection in Patients with Inflammatory Cardiomyopathy","volume":"110","author":"Chimenti","year":"2004","journal-title":"Circulation"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1378","DOI":"10.1016\/S0140-6736(03)14635-1","article-title":"Eosinophilic-lymphocytic myocarditis after smallpox vaccination","volume":"362","author":"Murphy","year":"2003","journal-title":"Lancet"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e007636","DOI":"10.1161\/CIRCHEARTFAILURE.120.007636","article-title":"Virus-Negative Myopericarditis in Human Coronavirus Infection: Report From an Autopsy Series","volume":"13","author":"Frustaci","year":"2020","journal-title":"Circ. Hear. Fail."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/6\/1660\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:37:44Z","timestamp":1760135864000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/6\/1660"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,16]]},"references-count":8,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2022,3]]}},"alternative-id":["jcm11061660"],"URL":"https:\/\/doi.org\/10.3390\/jcm11061660","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,16]]}}}