![]() Past medical history includes psoriatic arthritis, osteoarthritis, hypothyroidism and chronic colitis. The first and second doses of Pfizer BioNTech COVID‐19 vaccination were administered 76 and 55 days prior to review, respectively. Secondary follicles are variable in size and shape with well‐defined germinal centres.Ĭase 2: 70‐year‐old woman with a six‐week history of left supraclavicular lymphadenopathy. This study was deemed out of scope by the New Zealand Health and Disability Ethics Committees on 9 April 2022.Ĭase one photomicrograph showing supraclavicular lymph node with reactive follicular hyperplasia. Investigations and procedures include radiological imaging, FNA and excisional biopsy. History includes site and side of lymphadenopathy, duration of lymphadenopathy, relevant past medical history, vaccination status, site and side of vaccination and timing of vaccination prior to onset of lymphadenopathy. Patient demographics include age, gender and ethnicity. Relevant clinical information was obtained from charts and electronic records including patient demographics, presenting history, investigations, and procedures. They are followed by a departmental cancer tracking team and are easily identified by clinicians to add to this study. Cervical lymphadenopathy referrals are triaged as ‘high suspicion of cancer’ and are seen urgently as per the faster cancer treatment targets set by the Ministry of Health. During the study period four patients within Northland District Health Board and one patient within Waikato District Health Board were identified as having cervical lymphadenopathy presumed secondary to COVID‐19 vaccination with the Pfizer BioNTech COVID vaccine. Exclusion criteria were no history of vaccination, or lymphadenopathy present before vaccination. Inclusion criteria were adult patients with cervical lymphadenopathy following vaccination. We present a series of five cases of cervical lymphadenopathy arising after Pfizer BioNTech COVID‐19 vaccination.īetween 15/7/21 and respective hospital database was analysed for patients referred to the local Otorhinolaryngology (ORL) Head and Neck service. 1, 10 Diagnostic investigations include imaging and invasive procedures such as fine needle aspiration (FNA) and biopsy to exclude malignancy. 1, 6, 7, 9, 10 The differential diagnoses for cervical lymphadenopathy include infection, malignancy, medications, autoimmune disease, trauma and metabolic disease. 9 However, a number of cases of cervical lymphadenopathy post COVID‐19 mRNA vaccination have been reported. 7 The usual lymphatic drainage of the upper limb is via superficial lymphatic vessels which drain to the axillary lymph nodes and the subclavian lymphatic trunk. 8 Regional axillary lymphadenopathy has been reported as an immunogenic reaction to intramuscular administration in the deltoid. 1, 6, 7 A safety study of the BNT162b2 mRNA vaccine identified lymphadenopathy in 0.3% of participants. 5, 6 Lymphadenopathy is an uncommon side effect of other vaccinations and is rarely reported in human papillomavirus, tuberculosis and influenza vaccination. Listed side effects include pain and swelling at the injection site, tiredness, fatigue, headache, myalgia, chills, arthralgia, fever, erythema at injection site, nausea, feeling unwell, insomnia, unilateral facial droop, myocarditis and anaphylaxis as well as lymphadenopathy. 4 The vaccine is usually administered by intramuscular injection into the deltoid muscle. ![]() 2 In New Zealand, >94% of eligible population has been double vaccinated while >70% have had their booster dose. In New Zealand, the Pfizer BioNTech BNT162b2 mRNA vaccine (Comirnaty) has been provisionally approved for use and has been almost exclusively used. 3 Pfizer BioNtech, Janssen, AstraZeneca and Novax are some of the vaccinations have been used globally. 2 More than four and a half billion people across the world have been double vaccinated against COVID‐19. Provisionally approved COVID‐19 vaccines have been assessed to be safe and effective and can reduce the risk of contracting and spreading the virus as well as reducing the severity of symptoms of COVID‐19. Vaccinations have been developed globally to reduce the overall severity and mortality of COVID‐19 and limit the burden on healthcare systems. 1 Various strains of the COVID‐19 virus have spread including Delta and more recently Omicron. It has spread across the world and was officially announced as a pandemic by the World Health Organization (WHO) in March 2020. Coronavirus disease 2019 (COVID‐19) is a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) which was first detected in China in 2019. ![]()
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