Images of COVID-19 Vaccination

Rozin AP and Yalonetsky S

Published on: 1970-01-01


A 62-year old man is on chronic dialysis 5 years due to chronic renal failure. He has 40-year FMF history treated with colchicine without pericarditis events. The patient had severe fatigue, extreme weakness, abdominal pain and hypotension on admission. Eight days before he got the first Covid-19 vaccine. Then he felt well. Last dialysis was 2 days before current hospitalization. He indicated heart rate 120 per minute, blood pressure 90/40, respiratory distress, muffled heart tones, low lung dullness, and decreased inspiration sounds. The CT angiogram showed large pericardial effusion and mild to moderate pleural effusion. Transthoracic echocardiography (ECHO) showed large pericardial effusion with collapsed right heart. His 12 leads ECG showed low voltage with electrical alternance and old inferior scar post myocardial infarction. Urgent pericardiocenthesis disclosed 700 ml sero-sanguinose fluid with 600 leucocytes/mm3, most polymorphonuclears.  No bacterial, viral pathogens or malignant cells observed in the pericardial fluid. Immuno-serology was negative for infection and autoimmune diseases. Control ECHO twice showed no return of pericardial effusion and the drain evacuated on the 3-rd day without additional therapy. FMF pericarditis as the first and very late manifestation of the patient treated with colchicine seems unlikely. General practitioner was informed and second vaccine canceled as life threatening.  Multiple reports about corona virus induced cardiac tamponade bring for consideration of possible S-protein-immune system competetion. Lifesaving COVID-19 vaccination may be dangerous for very ill and debilitated patients. We should be ready to choose appropriate population for vaccination and to diagnose life-threatening complications early.