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Eosinophilic Myocarditis Temporally Associated With Conjugate Meningococcal C and Hepatitis B Vaccines in Children

Barton, Michelle MBBS*; Finkelstein, Yaron MD†‡**; Opavsky, Mary Anne MD, PhD*; Ito, Shinya MD; Ho, Tommy MD; Ford-Jones, Lee E. MD*; Taylor, Glenn MD§; Benson, Lee MD; Gold, Ronald MD, MPH*

The Pediatric Infectious Disease Journal: September 2008 - Volume 27 - Issue 9 - p 831-835
doi: 10.1097/INF.0b013e31816ff7b2
Instructive Case

We report the first cases of tissue-proven eosinophilic myocarditis after single vaccine administration of conjugate meningococcal C and hepatitis B vaccine, respectively. The nature of histopathologic findings strongly supports hypersensitivity reaction and negates viral etiology, which is typically characterized by a lymphocytic infiltrate. Both episodes resolved with corticosteroid therapy.

To enhance discussion of our cases, we performed a systematic review of the literature on postimmunization myocarditis or pericarditis, and identified 37 publications, reporting 269 cases during the search period (1966–2007). Time of onset of cardiac symptoms in all patients ranged from 1 to 30 days postimmunization.

From the Divisions of *Infectious Diseases, †Clinical Pharmacology and Toxicology, ‡Emergency Medicine, §Laboratory Medicine, and ∥Cardiology, Department of Pediatrics, the Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada; and the **Clinical Pharmacology Unit, Division of Emergency Medicine, Children’s Hospital Boston, Boston, MA.

Accepted for publication February 22, 2008.

The first two authors have made an equal contribution to the manuscript.

Address for correspondence: Yaron Finkelstein, MD, Divisions of Emergency Medicine and Clinical Pharmacology and Toxicology, Department of Pediatrics, the Hospital for Sick Children, 555 University Ave., Toronto, Ontario M5G 1X8, Canada. E-mail:

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© 2008 Lippincott Williams & Wilkins, Inc.