Acute axillary lymphadenopathy detected shortly after COVID-19 vaccination found to be due to newly diagnosed metastatic melanoma

David M Gullotti, MD, MSE; Evan J Lipson, MD; Elliot K Fishman, MD; Steven P Rowe, MD, PhD

Radiology Case Reports (Mar 2022)

Acute axillary lymphadenopathy detected shortly after COVID-19 vaccination found to be due to newly diagnosed metastatic melanoma

David M Gullotti, MD, MSE,
Evan J Lipson, MD,
Elliot K Fishman, MD,
Steven P Rowe, MD, PhD

Affiliations

David M Gullotti, MD, MSE: The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Radiology Room 118, 21287 Baltimore, MD, USA; Corresponding author.
Evan J Lipson, MD: Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Elliot K Fishman, MD: The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Radiology Room 118, 21287 Baltimore, MD, USA; Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Steven P Rowe, MD, PhD: The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Radiology Room 118, 21287 Baltimore, MD, USA; Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA

Journal volume & issue: Vol. 17, no. 3
pp. 878 – 880

Abstract

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As the administration of COVID-19 vaccines continues to increase, so too does awareness of the associated ipsilateral axillary lymphadenopathy. This has created a diagnostic challenge in the field of radiology, in particular among patients with cancer, as post-vaccination reactive adenopathy has been reported to be mistakenly interpreted as malignancy. As radiology departments improve their protocols for obtaining vaccine-related patient history, and radiologists become acclimated to attributing axillary lymphadenopathy to recent COVID-19 vaccination, there is a risk of the pendulum swinging too far and under-diagnosing true oncologic disease. This report describes an otherwise healthy 53-year-old man who presented with discomfort due to ipsilateral axillary lymphadenopathy shortly after receiving a COVID-19 vaccine. Fine needle aspiration performed within 2 months of receiving the vaccine revealed metastatic melanoma and subsequent 18F-FDG PET/CT demonstrated intensely avid axillary and supraclavicular adenopathy without visualization of a primary lesion. This case serves as a cautionary report to remind clinicians to remain suspicious of possible underlying malignancy with the presence of axillary adenopathy, despite a history of recent COVID-19 vaccination.

Published in Radiology Case Reports

ISSN: 1930-0433 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Medicine (General): Medical physics. Medical radiology. Nuclear medicine
Website: https://www.sciencedirect.com/journal/radiology-case-reports

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