Elsevier

The Lancet

Volume 362, Issue 9393, 25 October 2003, Pages 1378-1380
The Lancet

Research Letters
Eosinophilic-lymphocytic myocarditis after smallpox vaccination

https://doi.org/10.1016/S0140-6736(03)14635-1Get rights and content

Summary

Smallpox is an eradicated viral disease that has re-emerged as a potential bioterrorism threat. Smallpox vaccination was historically the most effective defence measure against wild smallpox virus. The risk of myopericarditis after vaccination might limit this option. We report a case of biopsy-proven eosinophilic-lymphocytic myocarditis diagnosed in vivo with histological evidence for eosinophil-mediated cardiac myocyte necrosis shortly after smallpox vaccination. Furthermore, we report a beneficial haemodynamic response to high-dose corticosteroids. A better understanding of the aberrant immune mechanism of myocyte injury after smallpox vaccination might improve the risk/benefit assessment for people considering smallpox vaccination and better smallpox vaccines in the future.

References (5)

There are more references available in the full text version of this article.

Cited by (75)

  • Myocarditis associated with COVID-19 and its vaccines - a systematic review

    2022, Progress in Cardiovascular Diseases
    Citation Excerpt :

    Endomyocardial biopsy in patients with COVID-19 vaccine-induced myocarditis showed monocytes, neutrophils, and lymphocytic infiltrates, with interstitial edema.57 The overall use of CMR was higher in COVID-19 vaccine-induced myocarditis patients with many case series reporting almost 100% use in all patients.39,54,57 Common findings include myocardial or sub-epicardial edema, late gadolinium enhancement, increased T1 and T2 intensity, and wall motion abnormalities.

  • Myocarditis following mRNA Covid-19 vaccination: A pooled analysis

    2022, Vaccine
    Citation Excerpt :

    Histological findings from biopsy-confirmed cases indicate that cardiac inflammation is mainly lymphocytic with abundancy of CD3 + lymphocytes and CD68 + macrophages [53,64]. This pattern of inflammatory injury contrasts the findings of myocarditis following small-pox vaccination, which is characterized by eosinophilic predominance [69]. As a result, it may be assumed that the lymphocytic histological pattern may partially explain the mild clinical course of most mRNA Covid-19 vaccination-associated cases since giant cell or eosinophilic myocarditis have been linked with significantly higher mortality rates [70].

View all citing articles on Scopus
View full text