Chiao-Yun Tsai1,4*, Jiun-Yi Hsia1,3, Hsu-Chih Huang1, Chih-Yi Chen1,4, Jui-Hung Weng2 and Pan-Fu Kao2,3
1Department of Surgery, Division of Thoracic Surgery, Chung Shan Medical University Hospital, Taiwan 2Department of Nuclear Medicine, Chung Shan Medical University Hospital, Taiwan 3School of Medicine, Chung Shan Medical University, Taiwan 4Institute of Medicine, Chung Shan Medical University, TaiwanFulltext PDF
Introduction: Coronavirus Disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), has caused the ongoing global pandemic. It can manifest a wide range of complications depending upon the severity of infection and comorbidities of the patient. Therefore, vaccines are a significant measure to protect from COVID-19. Record as of August 29th, 2021, the COVID-19 pandemic worldwide in a total confirmed number of cases, 216 million cases, and 4.49 million cases of death. In Taiwan, 15,954 in a total number of diagnosed cases and 833 cases of death. Making it one of the deadliest pandemics in history. Case Report: We report two cases, one of a 64-year-old female with the medical history of adenocarcinoma of lung over left upper lobe status post lobectomy of left upper lobe and mediastinal lymph node dissection in 2012, pT2aN0M0, stage IB, under oral chemotherapy with UFUR for 2 years; complicated with supraclavicular lymph node metastasis and EGFR exon 19 deletion mutation status post supraclavicular lymph node excisional biopsy in February 2018, ypT2aN3M0, stage IIIB, under target therapy with Iressa till present days in 2021. The other is a 70-year-old male with a medical history of adenocarcinoma of lung over left upper lobe status post wedge resection of left upper lobe and mediastinal lymph node dissection in August 2021, pT1bN0M0, stage IA2. Both cases, who were underwent imaging with Positron Emission Tomography (FDG PET/CT) scan for diagnosis staging, has found to have hypermetabolic uptake (SUVmax: 5.3) in the dominant vaccinated side of deltoid muscle of ipsilateral left axillary level I-III lymph nodes due to the 1st dose of Moderna COVID-19 vaccine (mRNA-1273, Spikevax) administrated one month ago before (FDG PET/CT) scan. Conclusion: After reviewing the literature, ipsilateral injection side axillary lymphadenopathy has been reported. Therefore, especially in oncology patients, detailed history regarding COVID-19 vaccination inoculation time and injected arm should be obtained before imaging to ensure the accuracy of the staging/restaging and to avoid unnecessary biopsy and the possibility of a misdiagnosis.
Tsai C-Y, Hsia J-Y, Huang H-C, Chen C-Y, Weng J-H, Kao P-F. COVID-19 Vaccine-Induced Axillary Level I-III Lymphadenopathy in Lung Adenocarcinoma Patients on PET Scan - Case Report. Ann Clin Case Rep. 2021; 6: 2011..