10.5826/dpc.1204a171
text/xml
2160-9381
2165
en
Aram Boada
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
vaccination
Lymphadenopathy after COVID-19 vaccine mimicking lymph-node progression in a patient with metastatic melanoma
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Letter to the Editor
2022-10-31
2021-11-12
2022-10-31
2022-12-01
e2022171
Dermatol Pract Concept
Aram Boada
2022/10/31
10.5826/dpc.1204a171
e2022171
Dermatology Department. Hospital Universitari Germans Trias i Pujol. Universitat Autònoma de Barcelona. Badalona, Barcelona; Institut Investigació Germans Trias i Pujol (IGTP)
2160-9381
vaccination
en
e2022171
Lymphadenopathy after COVID-19 vaccine mimicking lymph-node progression in a patient with metastatic melanoma
https://dpcj.org/index.php/dpc/article/download/2165/1803
       Lymphadenopathy After COVID-19 Vaccine
     Mimicking Lymph-Node Progression in a Patient
              With Metastatic Melanoma
          Julia Verdaguer-Faja1, José Luis Manzano2, Sofía España2, Paula Cecilia Notta3,
                          Raul Vicente Rodriguez Iniesta4, Aram Boada1,5


1 Dermatology Department. Hospital Universitari Germans Trias i Pujol. Universitat Autònoma de Barcelona. Badalona, Barcelona, España.
2 Medical Oncology Department. Hospital Universitari Germans Trias i Pujol. Universitat Autònoma de Barcelona. Badalona, Barcelona,
   España.
3 Nuclear Medicine-PET Department. Hospital Universitari de Bellvitge. Universitat de Barcelona. Hospitalet de Llobregat, Barcelona,
   España.
4 Radiology Department. Hospital Universitari Germans Trias i Pujol. Universitat Autònoma de Barcelona. Badalona, Barcelona, España.
5 Institut Investigació Germans Trias i Pujol (IGTP). Badalona, Barcelona, España.



Citation: Verdaguer Faja J, Manzano JL, España S, Notta PC, Rodriguez Iniesta RV, Boada A. Lymphadenopathy After COVID-19 Vaccine
Mimicking Lymph Node Progression in a Patient With Metastatic Melanoma. Dermatol Pract Concept. 2022;12(4):e2022171.
DOI: https://doi.org/10.5826/dpc.1204a171
Accepted: February 19, 2022; Published: October 2022
Copyright: ©2022 Verdaguer Faja et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding author: Julia Verdaguer Faja, MD, Dermatology Department. Hospital Universitari Germans Trias I Pujol. Carretera de
Canyet s/n. 08916. Badalona (Barcelona), Spain. Phone: 0034934978813, E-mail: verdaguer.ju@gmail.com




Introduction                                                             Case presentation
COVID-19 vaccination has been rapidly implemented                        A 47-year-old male with BRAF mutant melanoma of the
worldwide, especially among patients with cancer. Local                  back and right axillar adenopathies underwent wide ex-
reactions with ipsilateral lymphadenopathy are among the                 cision and lymphadenectomy and started adjuvant treat-
most common side effects. A few cases of false-­positive                 ment with nivolumab. One month later, he presented
                              18
18-fluorodeoxyglucose ( FDG) PET/computed tomog-                         disease relapse with satellitosis and a contralateral ade-
raphy (CT) scan after COVID-19 vaccination have been                     nopathy in the left axilla, the latter detected by PET-CT.
reported [1,2]. This is especially important in oncologic                Treatment was changed to targeted therapy (dabrafenib
patients, such as in cutaneous melanoma, where these                     and trametinib), reaching complete remission. An FDG-
findings might pose difficulties during their follow-up and              PET/CT from February 2021 showed no active disease.
management.                                                              In May 2021, after eight months of targeted therapy, a




Letter to the Editor | Dermatol Pract Concept. 2022;12(4):e2022171                                                                       1
routine FDG-PET/CT showed substantial 18F-FDG avidity                  disease. Further questioning of the patient revealed that
in the left axilla, with multiple malignant-appearing lymph            he had received the second dose of the COVID-19 mRNA
nodes; no other foci were identified (Figure 1A). Given                vaccine (Moderna) in the left deltoid muscle 5 days prior
this finding, up to two ultrasound-guided biopsies were                to the routine PET/CT scan. Finally, a new PET/CT was
performed on the left axilla, describing at least one clearly          performed 4 months later and revealed complete resolu-
malignant-appearing adenopathy in the ultrasound exam-                 tion of the hypermetabolic left axillary nodes (Figure 2),
ination (Figure 1, B and C), and showing histologically                suggesting the diagnosis of reactive lymphadenopathy due
lymphoid hyperplasia with no evidence of microscopic                   to COVID-19 vaccine.




Figure 1. Imaging tests performed in May 2021. (A-D) Routine ¹⁸F-FDG-PET/TC: hypermetabolic lymphadenopathy in the left axillary re-
gion, the largest and with most metabolism of 13 mm (SUVmax: 3.9), suggestive of malignancy. (E) Sonographic exam of the left axilla after
PET/CT findings: left axillary lymphadenopathy of rounded morphology with displacement of the central fatty hilum at the expense of great
hypoechoic cortical thickening, sonographically suspicious. Core needle biopsy was taken from it.




                Figure 2. (A-D) 4-month control 18F-FDG-PET/TC, September 2021: normalization of hypermetabolic
                lymphadenopathies in the left axillary region: resolution of the pathologic nodal uptake.



2                                                                       Letter to the Editor | Dermatol Pract Concept. 2022;12(4):e2022171
Discussion                                                           appearance of hypermetabolic regional lymph nodes after
                                                                     its injection. Keeping this etiology in mind and following
Transient FDG uptake in normal or enlarged lymph nodes               some recommendations for scheduling the PET-CT is espe-
(mainly axillary, supraclavicular and cervical nodes) has            cially important when evaluating oncologic patients to avoid
­already been described after administration of several types of     misinterpretation.
vaccines [3,4]. This issue has also been observed now with the
COVID-19 vaccination [1,2], being more frequently seen in pa-
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                                                                        Mol Imaging. 2011;38(5):894-898. DOI: 10.1007/s00259-011
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about recent vaccination, and to perform FDG PET/CT be-                 MP. COVID-19 vaccination-related uptake on FDG PET/CT: An
fore or at least 2 weeks after (optimally 4–6 weeks after)              emerging dilemma and suggestions for management. Am J Roent-
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                                                                        PMID: 33646823.
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Letter to the Editor | Dermatol Pract Concept. 2022;12(4):e2022171                                                                        3
