Dados do Trabalho

Título

Case report of a 73-year-old patient with inclusion body myositis evolving with bradycardia after vaccine for covid.

RESUMO

Presentation: A 73-year-old male patient, from Manaus, Amazonas, previously diagnosed with Inclusion Body Myositis (IBM) confirmed in 2017 by the muscle biopsy method, which presented an inflammatory myopathic histological pattern with a large amount of COX- negative. The patient was taking prednisone 5mg/day, ramipril 10mg/day, hydrochlorothiazide 25mg/day and glicazinde 60mg/day at home. On the twenty-sixth day after the third dose of Pfizer vaccine for covid-19, the patient appears for an outpatient follow-up consultation for underlying disease and for investigation of complaining of lipothymia and vertigo, denying any other sign of infection. During the evaluation, dyspnea was verified in MRC Class 3 and, in physical examination, a heart rate of 34 bpm was verified. Due to the condition, the patient was immediately advised by our neurology team to go to the emergency hospital. In the emergency room, an electrocardiogram (ECG) was performed and a Complete Heart Block (CHB) was identified and the implantation of a temporary transvenous pacemaker was chosen as an emergency therapeutic approach, later, a permanent pacemaker was implanted. Patient was hospitalized for 21 days in an Intensive Care Unit (ICU) for follow-up and procedures, today he has relief from dyspnea and lipothymia. Discussion: Cardiovascular damage is a known comorbidity of myopathies and can evolve with functional and conduction limitations. For example, cases of atrioventricular conduction delay have already been reported in a patient with IBM and, similarly, cases of CHB after vaccination for COVID-19 have already been reported. However, the causes of CHB are vast, making it difficult, in some cases, to identify its etiology. Thereby, the interconnection between vaccination, CHB and IBM can be arduous. Final Comments: In this case, we present a possible correlation between the Pfizer vaccine for covid-19 and abnormal electrical conduction in a patient affected by IBM. However, some limitations should be mentioned: despite the temporal correlation between the vaccine dose and the onset of symptoms being suggestive of inference and the existence of subsidies for connection with the baseline diagnosis, tests were not performed to directly prove the correlation between the three factors.

Palavras Chave

Inclusion Body Myositis; COVID-19; Heart Block; Vaccine;