A Case of Myopericarditis and the HPV vaccine

Main Article Content

Angela H Pegram, PharmD, BCPS, CDCES Tara V Bush, PA-C

Abstract

Introduction: 


Human Papillomavirus (HPV) is the underlying etiology of numerous cancers and genital warts in both males and females.  Vaccines were developed against HPV to prevent transmission and arrest development of cancers caused by the virus.  Gardasil 9â is the newest vaccine, covering 9 serotypes of HPV and is recommended by the CDC for both males and females over 9 years of age in a series of vaccinations. Myopericarditis (including myocarditis and pericarditis) is not reported as an adverse reaction in the Gardasil 9â package insert.


Case Report


A healthy 18-year-old male with no significant past medical or social history received dose number 3 of HPV vaccine at his physician’s office.   Within 24 hours, he developed chills and a fever (normal HPV reactions) and then recovered without sequelae within 48 hours.  Three days later, he developed crushing chest pain, with arm tingling and jaw pain.  He was triaged directly to the emergency room where he had troponins of greater than 11000 and T wave inversions on his EKG.  Other diagnostic tests and labs showed normal heart anatomy and no early coronary artery disease.  He was diagnosed with myopericarditis by cardiology.  He was treated and recovered fully within 3 months.


Discussion


Using the WHO tool for adverse vaccine reactions, this case has a consistent causal relationship with vaccination.  This is the eleventh case of myopericarditis reported to the Vaccine Adverse Effects Reporting system for the HPV vaccine. 


Conclusion


Although rare, myopericarditis should be considered as a possible adverse effect from the human papillomavirus vaccine.

Article Details

How to Cite
PEGRAM, Angela H; BUSH, Tara V. A Case of Myopericarditis and the HPV vaccine. Medical Research Archives, [S.l.], v. 9, n. 12, dec. 2021. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/2649>. Date accessed: 25 apr. 2024. doi: https://doi.org/10.18103/mra.v9i12.2649.
Section
Case Reports

References

1. Hancock G, Hellner K, Dorrell L. Therapeutic HPV vaccines. Best Pract Res Clin Obstet Gynaecol. 2018. 47:59-72.
2. Giuliano AR, Lu B, Nielson CM et al. Age-Specific prevalence, incidence, and duration of HPV infections in a cohort of 290 US men. J Infect Dis. 2008. 198(6):827-835.
3. Partridge JM, Hughes JP, Feng Q et al. Genital HPV in men: Incidence and risk factors in a cohort of university students. J Infect Dis. 2007. 196(8):1129-1136.
4. Guiliano AR, Palefsky JM, Goldstone S et al. Efficacy of quadrivalent HPV vaccine against HPV infection and disease in males. N Engl J Med. 2011. 364(5):401-411.
5. Gardasil 9 package insert. Merck and Company; Whitehouse, NJ. Last revised August 2020. Accessed November 15, 2021.
6. Mei R. Myocarditis and pericarditis after immunization. Int J Cardiol. 2018. 273:183-186.
7. Kounis NG, Koniari I, de Gregorio C et al. Allergic reactions to current available COVID-19 vaccinations: Pathophysiology, causality, and therapeutic considerations. Vaccines 2021. 9:221.
8. Hajjo R, Sabbah DM, Bardaweel SK et al. Shedding the light on post vaccine myocarditis and pericarditis in COVID-19 and non-COVID-19 vaccines. Vaccine. 2021. 9(10):1186-1201.
9. Kak G, Raza M, Tiwari BK. Interferon-gamma (IFN-γ): Exploring its implications in infectious diseases. Biomol Concepts. 2018. 9:64–79.
10. Murira A, Lamarre A. Type-I interferon responses: From friend to foe in the battle against chronic viral infection. Front Immunol. 2016. 7:609.
11. Huber JP, David Farrar J. Regulation of effector and memory T-cell functions by type I interferon. Immunology. 2011. 132:466–474.
12. Wright MD, Fauci AS. Smallpox immunization in the 21st century. JAMA. 2003. 289:3306-3308.
13. Wehbe E. A catastrophic failure. Am J Med. 2011. 124(3):e7-e9.
14. deMeester A, Luwaert R, Chaudron JM. Symptomatic pericarditis after influenza vaccination. Chest. 2000. 117:1803-1805.
15. Dilber E, Karagoz T, Aytemir K et al. Acute myocarditis associated with tetanus vaccination. Mayo Clin Proc. 2003 78:141-1433.
16. Peyiere H, Hillaire-Buys D, Pons M et al. Acute pericarditis after vaccination against Hepatitis B. Rev Med Internae. 1997. 18:675-676.
17. Tozzi AE, Asturias EJ, Balakrishnan MR, et al. Assessment of causality of individual adverse events following immunization (AEFI): A WHO tool for global use. Vaccine. 2013. 31(44): 5041-5046.
18. Law YM, Lal AK, Chen S et al. Diagnosis and management of myocarditis: AHA scientific statement. Circulation. 2021. 144: e000-e000. (published online ahead of print).