We read with great interest the publication Systemic lupus erythematosus myocarditis after COVID-191 by Sogbe et al. describing a 72-year-old woman with pleuritic chest pain one week after receiving the third dose of BNT162b2 mRNA vaccine.1 Serological tests for cardiotropic infections were negative, but autoimmune screening revealed positive results for antinuclear antibodies at 1:160 dilution, anti-dsDNA, and anti-histone antibodies.1 Sogbe et al. suggested a diagnosis of systemic lupus erythematosus with cardiac affection.1 According to Sogbe et al., this is the first case report of lupus myocarditis after COVID-19 vaccination.1

It is understandable that the COVID-19 vaccine may cause a rheumatological problem. However, any possible background disease and co-morbidity must be ruled out. It is impossible to rule out pre- or post-vaccination immunological/rheumatological problems without laboratory investigation data. This is a clinical problem that might go unnoticed as a side effect of vaccination due to the presence of a confounding factor.2 Last, but no less important, silent and asymptomatic infection with COVID-19 is possible and may develop during or after vaccination.3 COVID-19 is another potential contributor to lupus myocarditis.