Case 1. A man aged 56 years with a history
of mild hypertension and hypertriglyceridemia was revaccinated on March 4.
On March 16, he had onset of influenza-like illness (ILI), chest discomfort
while lying flat, and pleuritic pain during inspiration; a clinical examination
revealed tachycardia. During the next 7 days, he had chest pain, dyspnea on
exertion, fever, chills, pallor, and left knee pain. All symptoms and signs
had resolved 17 days after vaccination. On day 23 post vaccination, an electrocardiogram
(ECG) indicated low R waves in the anterior leads, and borderline first-degree
AV block (PR interval: 0.21 msec). Echocardiogram revealed widening of the
pericardial space with minimal fluid collection, a normal ejection fraction,
and normal ventricular wall function. Chest radiograph demonstrated left basilar
atelectasis. The patient had normal troponin I, creatine kinase myocardial
band (CK-MB), C-reactive protein levels, and a normal erythrocyte sedimentation
rate. These findings are consistent with mild myopericarditis. The patient
recovered; a follow-up exercise cardiac perfusion scan was normal.