Lymphadenopathy Associated With the COVID-19 Vaccine

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has dominated nearly everyone's life since its initial outbreak in the Hubei province of China in December 2019. The disease had spread quickly throughout the world causing extensive, widespread morbidity, over two million deaths, and economical and social devastation over the entire world. Researchers and pharmaceutical companies around the globe have been racing to develop potent and safe vaccines for the disease. Pfizer-BioNTech COVID-19 vaccine followed by Moderna COVID-19 mRNA-1273 vaccine were the first to receive FDA approval. These vaccines are based on messenger RNA novel technology and considered efficient in preventing contagion ensuring safety. Known side effects for this vaccine have been reported as very similar to those known for other vaccines. Specifically, lymphadenopathy has not been considered a common manifestation of COVID-19 vaccination. Israel has been cited as leading in the introduction of these vaccines, which are available for every citizen older than 16 years. Here, we present the cases of three patients who developed lymphadenopathy after the first dose of Pfizer-BioNTech COVID-19 vaccine. Time elapsed from the injection until the appearance of the enlarged nodes, clinical symptoms, and sonographic features differed between the patients, but in all cases gradual regression was noted in the enlarged nodes until complete resolution. Accordingly, to our knowledge, this is the first report describing post-COVID-19 vaccine lymphadenopathy detailing the clinical aspects, sonographic features, and outcomes.

COVID-19 Vaccination Induced Lymphadenopathy in a Specialized Breast Imaging Clinic in Israel: Analysis of 163 cases

“…Yet these vaccination campaigns have never been so massive and deployed on a nation-wide basis as the current SARS -CoV-2 vaccine campaign in Israel. Recently, several case reports on the occurrence of post-COVID 19 vaccination axillary lymphadenopathy were published 4 , 5 , 6 , 7 , 8 . In February 2021, a scientific expert panel published recommendations regarding post vaccination lymphadenopathy for patients undergoing imaging that includes the axillae [ 9 , 10 ].…”

A Case of Cervical Lymphadenopathy After Vaccination Against COVID-19

“…Influenza, measles, smallpox, anthrax, and BCI vaccines have all been implicated in occasional axillary lymphadenopathy [ 1 ]. However, data from COVID-19 vaccine clinical trials suggest that the first two FDA-approved COVID-19 vaccines, the Pfizer-BioNTech and Moderna COVID-19 vaccines, which are based on the novel messenger ribonucleic acid (mRNA) technology, are highly immunogenic, with a large number of patients reporting both local and systemic reactions compared to other routine vaccines [ 4 ]. In addition, the early clinical experience of breast radiologists suggests that the two approved COVID-19 vaccines have caused numerous cases of unilateral axillary lymphadenopathy, which have been observed on breast imaging, including MRI [ 5 , 6 ].…”

Cervical lymphadenopathy following COVID-19 vaccine: Clinical characteristics and implications for head and neck cancer services

“…More recently, cases with CVAL have been described in reports from the United States, Spain, Israel and the UK. 8,[12][13][14][20][21][22] The available evidence has suggested that mRNA-based vaccines are likely more immunogenic than standard vaccines, and hence show higher incidence of CVAL. 7,21,22 In clinical trials on the Pfizer/BioNTech mRNA vaccine, lymphadenopathy was only reported as an unsolicited ADR, with incidence in the vaccine group as high as ten times that in the placebo group (0.3% and 0.03% respectively).…”

“…These findings are in line with previous reports that demonstrated that CVALs may show abnormal morphology, and can appear enlarged, rounded, hypoechoeic and with loss of echogenic fatty hila. 8,9,13,20 Implications for the Head and neck cancer services…”

“…7, 10,11 Cases of ipsilateral lymphadenopathy in the lower neck and supraclavicular region following COVID-19 vaccinations are quickly emerging in the international literature, and certainly being increasingly referred to the healthcare services for advice and management. [12][13][14] As lower neck lymphadenopathy usually harbours malignancy in around 75% of cases, the UK National Institute for Health and Care Excellence (NICE) recommended fast-track referral of unexplained or persistent cases through a dedicated pathway for suspected H&N cancer. 15,16 The differential diagnosis of lymphadenopathy in the lower neck is broad, but it is imperative to exclude pathologies like head and neck (H&N) malignancy, lymphoma, and metastatic lung or cutaneous cancers.…”