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. 2022 Sep;92(9):2286-2291.
doi: 10.1111/ans.17808. Epub 2022 Jun 10.

COVID-19 vaccine associated cervical lymphadenopathy: a case series

Chelsea L Heaven  1 , Lucy Barber  1 , Omid Ahmadi  2   3 , Kumanan Selvarajah  3 , Subhaschandra Shetty  1
Affiliations

COVID-19 vaccine associated cervical lymphadenopathy: a case series

Chelsea L Heaven et al. ANZ J Surg. 2022 Sep.

Abstract

Background: COVID-19 is an evolving worldwide pandemic causing significant morbidity and mortality. COVID-19 vaccinations have been developed to increase immunity against the virus. In New Zealand, the Pfizer BioNTech mRNA vaccine has been provisionally approved for use. Axillary lymphadenopathy is a recognized side effect of the mRNA vaccine, however cervical lymphadenopathy has also been reported. Due to a wide range of differential diagnoses, the finding of cervical lymphadenopathy requires thorough investigation which can include imaging and invasive diagnostic procedures.

Methods: Five patients were identified by otorhinolaryngology (ORL) consultants at Whangarei Base Hospital and Waikato Hospital between 15/7/2021 and 21/12/2021 after being investigated through high suspicion of cancer triage pathways set by the New Zealand Ministry of Health. Inclusion criteria were adult patients with cervical lymphadenopathy following vaccination. Exclusion criteria were no history of vaccination or lymphadenopathy present before vaccination.

Results: All patients were identified to have cervical lymphadenopathy on radiological imaging and a recent history of COVID-19 vaccination with the Pfizer BioNTech vaccine. Interval vaccination to fine needle aspiration time ranged between 41 and 76 days. All patients had cytological or histological diagnosis showing reactive findings or interval imaging showing resolution of lymphadenopathy.

Conclusion: With increasing levels of COVID-19 vaccination and booster vaccinations we will continue to see cases of COVID-19 vaccine associated cervical lymphadenopathy. We highlight the importance of taking a COVID-19 vaccination history and including COVID-19 associated cervical lymphadenopathy in the differential diagnosis of presentation with a neck lump.

Keywords: COVID-19 vaccine; cervical lymphadenopathy.

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Conflict of interest statement

None declared. The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee(s) and with the Helsinki Declaration (as revised in 2013). Written or verbal informed consent was obtained from the patients for publication of this case report and accompanying images.

Figures

Fig. 1
Fig. 1
Case one photomicrograph showing supraclavicular lymph node with reactive follicular hyperplasia. Secondary follicles are variable in size and shape with well‐defined germinal centres.
Fig. 2
Fig. 2
(a) Case 3 USS showing right level Va node with loss of hilar pattern and short axis of 5.4 mm. (b) case 3 USS 33 days later showing normal size and morphology. Short axis of 3.3 mm.
Fig. 3
Fig. 3
(a) High power photomicrograph and (b) low power micrograph of left level Ib lymph node showing a benign reactive lymph node.
See this image and copyright information in PMC

Comment in

References

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