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Regional Lymphadenopathy after COVID-19 Vaccine in a Cancer Patient: A Case Report

Author(s): Maen Abdelrahim, Abdullah Esmail

Background

The COVID-19 pandemic has led to more than 233 million confirmed cases and more than 4.7 million deaths (at the time of writing this case report) [1,2]. The U.S. Food and Drug Administration (FDA) authorized the emergency use for three vaccines against COVID-19 (Pfizer-BioNTech, Moderna and Johnson & Johnson’s Janssen) [3-5]. More than 92% of consistently high efficacy was described across age, sex, race, and different ethnicity, as well as among individuals with underlying medical conditions. In addition, efficacy was similarly observed in a secondary analysis where participants with or without evidence of previous SARS-CoV-2 infections were included [6]. Per the recommendations of Pfizer-BioNTech, the COVID-19 vaccine is administered as 2 doses separated by 21 days. The Pfizer-BioNTech vaccine has common side effects reported, which typically lasted several days and included pain at the injection site, muscle pain, chills, joint pain, tiredness, headache and fever [7]. Typically, most individuals experienced these side effects after the second dose compared to the first dose [8]. The objective of this clinical case report is to highlight a potential new side effect of the Pfizer-BioNTech vaccine against COVID-19 in cancer patients.

Case summary

Patient presented with Axillary puffiness associated with discomfort when touched after she has received the second dose of the Pfizer-BioNTech vaccine. She was diagnosed with Stage III rectosigmoid cancer in 2018 and was treated with rectosigmoid segmental colectomy. Surveillance Computed Tomography (CT) of the chest, abdomen and pelvis were done every six months. The most recent scans in September 2020 showed no evidence of disease. On December 19th 2020, the patient received the first dose of Pfizer-BioNTech vaccine against COVID-19 with no notable side effects. The second dose was received on January 8th 2021. The day after vaccination, the patient presented to clinic with complain of feeling discomfort in her right axilla associated with pain to light touch. The patient had no history of recent infection or fever. On clinical examination, swelling and tenderness were notable over patient’s right axilla that was associated with mild lymphadenopathy on the right axilla, but not abnormal findings in the left axilla. CT was done and revealed multiple enlarged right axillary, as well as subpectoral lymph nodes, without evidence of local recurrence or metastatic disease in the abdomen or pelvis. A week later, the patient had a follow-up clinic visit where it was noted that her symptoms of right axilla resolved.

Conclusions

Regoinal (axillary) lymphadenopathy, that lasted approximately one week, can be seen in a cancer patient after she received the second dose of the Pfizer-BioNTech vaccine against COVID-19. These findings should be taken into consideration when oncologists conduct their survillenace and/or restaging scans for patients who are actively being treated for or have prior history of cancer.

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