PMC8803643_01
Timeline of the case and cardiac MRI findings. (A) Time of ChAdOx1 nCoV-19 vaccination, onset of clinical symptoms, and treatment regimens. (B) Time course of laboratory parameters including LDH, AST, ALT, gamma-GT, and AP after admission. (C) LGE confirming circumferential thickening and contrast enhancement of the entire pericardium (yellow arrowheads) without presenting myocardial enhancement. Advanced tissue characterization with T2 mapping and post contrast T1 mapping did not show evidence of myocardial edema or myocardial enhancement, confirming the diagnosis of isolated pericarditis. ALT, alanine aminotransferase; AP, alkaline phosphatase; AST, aspartate aminotransferase; CMV, cytomegalovirus; gamma-GT, gamma-glutamyl transferase; LGE, late gadolinium enhancement; MRI, magnetic resonance imaging.
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Two weeks after vaccination, the patient suffered from fever, weakness and arthralgia of the knees, hips and shoulders ( Figure 1A ). After additional 3 weeks, the patient was admitted to a community hospital with stable vital parameters and normal physical examination ( Figure 1A ). Because both, antibiotic treatment with piperacillin/tazobactam and steroids did not improve clinical symptoms with persistent fever and weakness, the patient was referred to our tertiary center three weeks thereafter ( Figure 1A ). During the further disease course, elevated liver transaminase levels including alanine aminotransferase (ALT: 339 U/L, reference range: <=34 U/L), aspartate aminotransferase (AST: 295 U/L, reference range: <=31 U/L), canalicular enzymes gamma-glutamyl transferase (gamma-GT: 469 U/L, reference range: 9-36 U/L), and alkaline phosphatase (AP: 452 U/L, reference range: 40-150 U/L) were detectable ( Figure 1B ). C virus (HCV), hepatitis E virus (HEV) infection, and human immunodeficiency virus (HIV). Cardiac magnetic resonance imaging (MRI) confirmed diagnosis of pericarditis with circumferential thickening and contrast enhancement of the entire pericardium at late gadolinium enhancement (LGE,  Figure 1C ). Based on active CMV infection, oral valganciclovir was initiated (900 mg twice daily,  Figure 1B ). During the further course, clinical symptoms improved, and liver enzymes normalized ( Figure 1A ). Thereafter, the patient remained free of symptoms and was discharged with recommendation to continue the antiviral therapy for 3 weeks in total ( Figure 1A ).