Resolution of Refractory COVID-19 Vaccine-Induced Myopericarditis with Adjunctive Rapamycin

COVID-19 vaccine-induced myopericarditis is now commonly encountered in clinical practice. The mainstay of clinical management involves vaccine Spike protein detoxification and colchicine for 12 months or longer. Herein, we present a case of a previously healthy 23-year-old male with autism spectrum disorder who developed COVID-19 vaccine-induced myopericarditis and class II heart failure. He was treated with Spike detoxification, which is the combined use of over-the-counter nattokinase, bromelain, and curcumin, in addition to colchicine. While transient heart failure resolved, his chest discomfort persisted and at times was debilitating. Serial electrocardiograms indicated persistent global ST segment elevation. We describe the successful addition of off-label oral rapamycin to arrest inflammatory processes, extirpate ST elevation, and significantly improve quality of life. We summarize existing research that provided a rationale for the use of rapamycin. Concisely, these include targeting autophagy, mRNA translation, and immune activity modulation. We propose that mTOR inhibitors should be investigated as a potential disease-modifying interim treatment for COVID-19 vaccine induced cardiac injury.