Abstract
Background: Myocarditis is a recognized but rare complication of smallpox immunization.
It typically presents within 30 days of immunization and on initial presentation shares
many characteristics with acute coronary syndrome. Electrocardiogram findings, elevated
cardiac enzymes, and undifferentiated chest pain require immediate implementation
of therapy directed towards an acute coronary syndrome. In an austere environment,
access to advanced care may be limited. Objectives: Smallpox vaccine-mediated myocarditis
may present, typically within 30 days of immunization, in such a fashion that it is
impossible to distinguish from acute myocardial infarction. The purpose of this article
is to alert the clinician to this problem and to provide information to assist in
making a suitable diagnosis and disposition in the absence of an absolute diagnosis.
Case Report: We present a case of smallpox vaccine-associated myocarditis in an American
serviceman deployed in Iraq, and review the literature to determine management of
these cases in an emergency setting. Conclusions: This case serves to increase awareness
of the association of vaccine-mediated myocarditis in the month after immunization,
and the fact that it may present similar to infarction. If the clinical probability
of myocarditis is greater than infarction, this will lead the clinician to different
treatment modalities.
Keywords
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Article info
Publication history
Published online: February 02, 2009
Accepted:
August 10,
2008
Received in revised form:
July 2,
2008
Received:
February 21,
2008
Footnotes
The opinions expressed in this article represent the views of the authors and do represent any official view, statement, or policy by the Department of Defense. The authors do not have any affiliation or monetary relationships with any organization that should be additionally detailed or described.
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Published by Elsevier Inc.
