Hypermetabolic lymphadenopathy following the administration of COVID-19 vaccine and immunotherapy in a lung cancer patient: a case report

Abstract

Background Given the current climate of the pandemic, lung cancer patients are especially vulnerable to complications from severe acute respiratory syndrome coronavirus 2 infection. As a high-risk population group, these patients are strongly advised to receive coronavirus disease 2019 vaccination in accordance with Center for Disease Control and Prevention guidelines to minimize morbidity and mortality. In recent years, immunotherapy has taken a preeminent role in the treatment of non-small cell lung cancer with dramatic improvement in overall survival. Reactive lymphadenopathy following the administration of a coronavirus disease 2019 vaccination can confound the radiographic interpretation of positron emission tomography–computed tomography or computed tomography scans from lung cancer patients receiving immunotherapy. Case presentation Here, we present a case of a 61-year-old Caucasian female and former smoker who developed cervical, hilar, supraclavicular, mediastinal, and left retroauricular lymphadenopathy following her coronavirus disease 2019 booster vaccination. At the time, she had been receiving long-term immunotherapy for the treatment of advanced lung adenocarcinoma. Biopsy was pursued owing to concerns of treatment failure and confirmed recurrent malignancy. Conclusion This case report highlights the importance of lymph node biopsies in lung cancer patients who present with contralateral lymphadenopathy following coronavirus disease 2019 vaccination to rule out tumor recurrence in this deserving patient population.

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“…During the search, the authors placed no restrictions on the year of publication and searched reference lists of full-text articles, mainly those of systematic reviews for additional studies that were not identified in the initial search. Only literature published in English was selected, including studies that reported histopathological and/or cytological findings in COV-ID-19 vaccine-related lymphadenopathy [22,[25][26][27][28][29][30][31][32][33][34]. Studies on SLDI, mainly detected by US or 18F-FDG PET-CT were also selected and used for a general comprehension and description of the phenomenon and to retrieve cases evaluated by histology or LN-FNAC [68][69][70][71][72][73][74][75][76][77].…”

“…When reported, most cases of lymphadenopathy occurred on the same side of the vaccination site, with contra-laterality reported in four cases (4/54, 7%) [31,33,44,47]. The most common site of lymphadenopathy was the axillary region (28/55, 51%), followed by the clavicular (13/55, 24%) and cervical regions (6/55, 11%).…”

“…This review focused on the reported histopathological features of C19-LAP up to the 2021. Nonetheless, other than histopathology, core-needle biopsy (CNB) and fine-needle aspiration cytology (FNAC) may be used for both reactive processes and lymphoma or metastases and have been utilized to assess LAP during the pandemic [6,25,[32][33][34][35][36][37][38][39]. In this study, a review of C19-LAP reports between January 2021 up to December 2023 has been performed including both cytological and histopathological reports which were analyzed according to the lymphadenopathy and vaccines types.…”

“…Main COVID-19 vaccines and corresponding lymphadenopathy as side effects, as reported by Caputo et al[33]. The table was included with the permission of the authors.…”

SARS-CoV-2 infection and COVID-19 vaccination in cancer patients undergoing immune checkpoint inhibitors

“…Similarly, we searched for cases in which patients who had previously used ICI received COVID-19 vaccine. A total of 13 cases of adverse reactions following the COVID-19 vaccination were reported in cancer patients treated with ICIs (Table 3 ) [ 53 – 65 ]. The median age was 55.5 (25–75) years, and males accounted for 53.8%.…”