Hypersensitivity Myocarditis and the Pathogenetic Conundrum of COVID-19 Vaccine-Related Myocarditis
Nicholas G. Kounis, Ioanna Koniari, Virginia Mplani, Panagiotis Plotas, Dimitrios Velissaris
Abstract
Myocarditis is a rare side effect of the mRNA vaccines with uncertainty around its pathogenesis and frequency. Its incidence varies from 1.4 to 4.2 per 100 000 vaccinated individuals. The incidence in Denmark found of 1.4 per 100 000 vaccinated with BNT162b2 individuals and in analysis using a 14 day post-exposure window the vaccine was associated with myocarditis only in female, not male, participants fact inconsistent with international data, and difficult to explain. In the important review published in Cardiology [3] the authors correctly referred to active vaccine component, as possible cause of myocarditis and speculated on mRNA immune reactivity, antibodies to SARS-CoV-2 spike glycoproteins cross-reacting with myocardial contractile proteins, hormonal differences depending on age, sex and immune–genetic background. This report raises issues on type, pathogenesis, causality and new therapeutic perspectives