1 市立旭川病院小児科Department of Pediatrics, Asahikawa City Hospital ◇ Hokkaido, Japan
2 日鋼記念病院小児科Department of Pediatrics, Nikko Memorial Hospital ◇ Hokkaido, Japan
新型コロナウイルスワクチン関連心筋炎（C-VAM）は稀ではあるが，各国より報告され注目されており，今後のワクチン接種人口の増加により遭遇する機会が増える可能性がある．今回，半年以上に渡り心臓MRI（CMR）の異常所見が残存したC-VAM症例を経験したので報告する．症例は14才男児で新型コロナウイルスmRNAワクチン2回目接種後に発熱と胸痛が出現した．心電図変化と血清トロポニンI高値，およびCMRにて心筋炎と合致する所見があり，C-VAMと診断した．急性期はごく軽症で対症療法のみで軽快したが，心電図の正常化には1か月以上を要し，また罹患1年後のCMRでも遅延造影（LGE）での異常所見が残存していた．現時点でC-VAMの長期予後は不明であるが，C-VAM以外の心筋炎ではLGE所見の残存が長期予後と関連があると言われており，急性期が軽症であったとしても，長期の経過観察が必要と考えられた．
Coronavirus disease 2019 vaccine-associated myocarditis (C-VAM) is a rare complication, but it has been reported and has attracted attention from various countries. C-VAM occurrences may increase with the rise in the number of people vaccinated. Here, we report a case of C-VAM with persistent abnormal findings on cardiac magnetic resonance imaging (CMR) for one year after disease onset. A 14-year-old male patient presented with fever and chest pain after receiving the second dose of the coronavirus mRNA vaccine. Electrocardiogram (ECG) changes, elevated serum troponin I level, and abnormal CMR findings indicated C-VAM diagnosis. The acute phase was very mild which improved in a few days with symptomatic treatment alone; however, the ECG normalized after more than a month, and abnormal findings on late gadolinium enhancement (LGE)-CMR remained one year after disease onset. The long-term prognosis of C-VAM remains unclear. Residual LGE findings in non-C-VAM acute myocarditis have been associated with long-term prognosis. Therefore, long-term follow-up is necessary for C-VAM despite the mild clinical course of the acute phase.
Key words: coronavirus disease 2019 vaccine-associated myocarditis; cardiac magnetic resonance imaging
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