Unilateral axillary lymph node fluorodeoxyglucose uptakes after coronavirus disease 2019 vaccination

Document Type : Case report

Authors

Department of Radiology, Kurume University School of Medicine, Japan

Abstract

Vaccination against coronavirus disease 2019 (COVID-19) started in early December 2020 worldwide, and healthcare workers in Japan were vaccinated in February 2021. We encountered three patients who underwent 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for cancer screening at our institution, showing FDG uptakes in the axillary lymph nodes, which seemed to be reactive changes. Two of them were males in their 40s and one was a female in her 50s; all of them were healthcare workers. The medical history revealed that they received the Pfizer-BioNTech COVID-19 vaccination twice at their left shoulders before the FDG PET/CT examination. The degree of FDG uptakes were maximum standardized uptake value (SUVmax)=3.2–9.9, SUVmax=5.9–10.3, and SUVmax=2.8–7.9, respectively. They were diagnosed with reactive lymph nodes because of vaccination owing to the absence of abnormal FDG PET/CT findings at other sites. As COVID-19 vaccination becomes more widespread in Japan, radiologists should be aware of these findings to avoid misdiagnosis of FDG uptakes in pathological lymph nodes and to prevent unnecessary additional examinations. Recently, similar FDG PET/CT findings have been reported after receiving the COVID-19 vaccination, and we will report it with a literature review.

Keywords


  1. Brierley JD, Gospodarowicz MK, Wittekind C: TNM classification of malignant tumours, 8th ed. Chichester: John Wiley & Sons; 2017.
  2. Local reactions, systemic reactions, adverse events, and serious adverse events: Moderna COVID-19 vaccine. Centers for Disease Control and Prevention. https:// www.cdc.gov/ vaccines/ covid-19/ info-by-product/moderna/ reactogenicity.html. Accessed 11 Feb 2021.
  3. Baden LR, El Sahly HM, Essink B, Kotloff K, Frey S, Novak R, et al. Efficacy and safety of the mRNA-1273 SARS-CoV-2 vaccine. N Engl J Med. 2021; 384(5):403-416
  4. Shirone N, Shinkai T, Yamane T, Uto F, Yoshimura H, Tamai H, et al. Axillary lymph node accumulation on FDG-PET/CT after influenza vaccination. Ann Nucl Med. 2012; 26(3):248-252.
  5. Panagiotidis E, Exarhos D, Housiana- kou I, Bournazos A, Datseris I. FDG uptake in axillary lymph nodes after vaccination against pandemic (H1N1). Eur Radiol. 2010; 20(5):1251-1253.
  6. Burger IA, Husmann L, Hany TF, Schmid DT, Schaefer NG. Incidence and intensity of F-18 FDG uptake after vaccination with H1N1 vaccine. Clin Nucl Med. 2011; 36(10):848-853.
  7. Lehman CD, D’Alessandro HA, Mendoza DP, Succi MD, Kambadakone A, Lamb LR. Unilateral lymphadenopathy after COVID-19 vaccination: A practical management plan for radiologists across specialties. J Am Coll Radiol. 2021; 18(6):843-852.
  8. Cohen D, Krauthammer SH, Wolf I, Even-Sapir E. Hypermetabolic lymphadenopathy following administration of BNT162b2 mRNA Covid-19 vaccine: Incidence assessed by [18F] FDG PET-CT and relevance to study inter-pretation. Eur J Nucl Med Mol Imaging. 202148(6):1854-1563.
  9. Eifer M, Tau N, Alhoubani Y, Kanana N, Domachevsky L, Shams J, et al. Covid-19 mRNA vaccination: Age and immune status and its association with axillary lymph node PET/CT uptake. J Nucl Med. 2021: jnumed.121.262194.
  10. Boyarsky BJ, Werbel WA, Avery RK, Tobian AAR, Massie AB, Segev DL, et al. Immunogenicity of a single dose of SARS-CoV2 messenger RNA vaccine in solid organ transplant recipients. JAMA. 2021; 325(17):1784-1786.
  11. Monin-Aldama L, Laing AG, Munoz-Ruiz M, McKenzie DR, del Barrio ID, Alaguthurai T, et al. Interim results of the safety and immune-efficacy of 1 versus 2 doses of COVID-19 vaccine BNT162b2 for cancer patients in the context of the UK vaccine priority guidelines. medRxiv. March 17, 2021.
  12. Lederer K, Castaño D, Atria DG, Oguin III TH, Wang S, Manzoni TB, et al. SARS-CoV-2 mRNA vaccines foster potent antigen-specific germinal center responses associated with neutralizing antibody generation. Immunity. 2020; 53(6):1281-1295.
  13. Turner JS, O’Halloran JA, Kalaidina E, Kim W, Schmitz AJ, Zhou JQ, et al. SARS-CoV-2 mRNA vaccines induce a robust germinal centre reaction in humans. Res Square. 2021:1-8.
  14. Cohen D, Krauthammer SH, Cohen YC, Perry C, Avivi I, Herishanu Y, et al. Correlation between BNT162b2 mRNA Covid-19 vaccine-associated hypermetabolic lymphadenopathy and humoral immunity in patients with hematologic malignancy. Eur J Nucl Med Mol Imaging 2021; 48(11):3540-3549.
  15. McIntosh LJ, Bankier AA, Vijayaraghavan GR, Licho R, Rosen MP. COVID-19 vaccination-related uptake on FDG PET/CT: An emerging dilemma and suggestions for management. AJR Am J Roentgenol 2021; 217(4):975-983.