Axillary Lymph Node Swelling After COVID-19 Booster Vaccination: Japanese Case Report and Literature Review

Abstract

Background/Aim: COVID-19 has been a global pandemic for more than 2 years, and vaccination against COVID-19 using an mRNA vaccine is widespread. The COVID-19 vaccination can cause specific side-effects, such as axillary lymph node swelling; therefore, breast oncologists should pay attention to such occurrences. Initially, only two COVID-19 vaccinations were planned; however, in some countries third or fourth vaccines have been administered. Here, we present a female case who developed axillary lymph node swelling after her third vaccination. We have also reviewed the literature regarding this side-effect after a third or fourth COVID-19 vaccination. Case Report: A 64-year-old woman who came to our clinic regarding a mammography abnormality in her left breast. She had no palpable mass, but a left breast mass was shown by mammography, and ultrasonography and magnetic resonance imaging indicated a hamartoma. At 2 months after her second COVID-19 vaccination when she underwent these tests, she had no axillary lymph node swelling. We planned a follow-up after 6 months. At her next visit, by chance, she underwent ultrasonography 14 days after she received a third COVID-19 vaccination, and a swollen axillary lymph node was observed. Conclusion: Axillary lymph node swelling can occur after a third COVID-19 vaccination. Therefore, breast oncologists will have to consider this side-effect of COVID-19 vaccination when diagnosing breast tumors. Pneumonia caused by the novel coronavirus, called Coronavirus Disease 2019 (COVID-19), was first reported in Wuhan, China in December 2019 (1). Two years later and the pandemic has become global. During this pandemic, COVID-19 vaccines, such as the BNT162b2 vaccine (Pfizer) (2) and mRNA-1273 vaccine (Moderna) (3), have been developed rapidly, and in many countries, including Japan, vaccination with these vaccines has been performed. BNT162b2 and mRNA-1273 are mRNA vaccines and this is the first time this type of vaccine has been used in a clinical setting.When these vaccinations were started, clinical trials of BNT162b2 and mRNA-1273 (2, 3) were designed to administer two doses. However, this pandemic has continued for 2 years, and therefore booster vaccinations have been required to prevent COVID-19 infection because antibody levels to the virus decrease within several months. In Japan, the third vaccination started in December 2021 (4). Currently, a third vaccination is indicated for those who received a second vaccination more than 6 months previously, and further vaccination might be needed. Indeed, Japan is planning to administer a fourth COVID-19 vaccination (5).These vaccines have characteristic side-effects including fever, general fatigue, injection-site pain, and swelling (2). In addition, local lymph node swelling can also occur after these vaccinations (3). In cases of axillary lymph node swelling, breast oncologists should consider whether these swellings are metastases of breast cancer or a side-effect of the vaccine. Here, we present a case with axillary lymph node swel...

Side effects of Pfizer/BioNTech (BNT162b2) COVID-19 vaccine reported by the Birzeit University community

“…In this study, participants with comorbid diseases were at higher risk of developing post-vaccination side effects, including increased blood pressure, heart rate, shortness of breath, voice hoarseness, dizziness, nausea, diarrhea, abdominal pain, and myalgia (muscle pain). These findings support the results of studies from the Arab region by Ma’mon M. Hatmal [ 31 ] and Saudi Arabia by Alghamdi et al [ 43 ], which showed that chronic diseases are associated with developing post-vaccination side effects. However, further studies are needed to explain the causes of increased side effects following different COVID-19 vaccinations in comorbid people.…”

“…The localized lymphadenopathy (enlarged axillary nodes) reported in this study aligns with the first Therapeutic Goods Administration’s COVID vaccine safety report of 2022, which is more common in the mRNA booster dose [ 28 , 29 ]. Enlarged axillary nodes are a normal response caused by a robust vaccine-elicited immune response due to the proliferation of rapidly activated immune cells (residual effector cells) from previous doses [ 30 , 31 ].…”