Atypical cervical mass after Covid-19 vaccination

Introduction Vaccinations cause an immune reaction that may present as lymphadenopathy. The latter is increasingly reported after Sars-Cov-2 vaccination, especially after mRNA-based vaccines.

Case Report We report a case of a 67-year-old man who presented with left cervical swelling. He complained of progressive neck tenderness and dysphagia. Sonography revealed a large, hypoechoic mass in the left cervical region. The CT scan showed a central confluence of the lesion, but no further significant findings. The patient history yielded the abuse of noxious substances, which gave rise to the suspicion of CUP. A panendoscopy with blind biopsies and a punch biopsy of the lesion were performed. Histologically, the punch biopsy showed an inflammatory process. The sample biopsies from the tonsil lodge and the base of the tongue showed no evidence of malignancy. The patient had received the fourth Sars-Cov-2 (BionTech) vaccination 4 days prior to symptom onset at the left upper arm. A few days after the punch biopsy, the lesion showed signs of regression. Four months later, only an enlarged lymph node was found at the site.

Discussion A cervical mass requires further examination, especially if the morphology is suspicious or certain risk factors are present. In view of the current pandemic situation, however, a post-vaccinal lymphadenopathy should always be considered as differential diagnosis.

Publication History

Article published online:
12 May 2023