Axillary swelling or tenderness due to ipsilateral lymphadenopathy in the vaccination arm has recently been reported as an uncommon adverse reaction after the Pfizer–BioNTech vaccine (affecting up to one in 100 people) and as very common after the Moderna vaccine (up to one in 10 people). Axillary lymphadenopathies after vaccination have been described for live attenuated vaccines such as Bacillus Calmette–Guérin, measles-mumps-rubella or varicella but also, more exceptionally, for inactivated vaccines. Although the most frequent cause is infection, neoplastic origin is also possible, particularly in certain locations such as the supraclavicular fossa. Regional lymphadenopathies may constitute a sign of medical concern. Cases are being followed up: all of them have improved clinically, and 15 completely resolved between 5 and 16 days since onset. The rest of their physical examination was unremarkable. There were no signs of excess inflammation in the deltoid region. In three cases, infraclavicular lymphadenopathies with the same characteristics were also present. Twelve of the 20 patients spontaneously reported that the intramuscular injection point was unusually high, and nearly all (17/20) acknowledged a similar perception when they were asked about this specifically (either compared with the previous dose administration or in relation to their theoretical expectation about the exact location of the point of injection). All of them completed the two-dose vaccination schedule. In six cases, the symptoms occurred after the first vaccine dose, while the remaining 14 happened after the second dose. Systemic lupus erythematosus, Sjögren syndromeĪ Ultrasonography and fine-needle aspiration puncture.ī Ultrasonography, mammography, and fine-needle aspiration puncture. Onset date of symptoms (days since vaccination) The remaining patient detected the adenopathy 24 days after vaccination, prompted by contact with another affected case, but she retrospectively recognised minor local symptoms in the preceding days. All lymphadenopathies had inflammatory symptoms (pain, swelling), were rounded and mobile, and all but one appeared in the first 24 h to 9 days after vaccine administration. In one patient, a mammography was also performed, with no pathological finding. In five patients, fine needle puncture aspiration was performed with results showing reactive inflammatory signs, with lymphocytic infiltrate and active germinal centres. Two of the cases had a prior history of thyroid disease (follicular adenoma and thyroid cancer), a third case was diagnosed with autoimmune thyroiditis in the course of the diagnostic work-up, and another two cases had Sjögren syndrome (one associated with hypertension and the other with systemic lupus erythematosus). None had a history of severe or unusual adverse reactions following immunisation. The lymphadenopathy appeared 7 days after the second vaccine dose and it is in resolution.Īll 20 cases were women, with ages ranging from 25 to 60 (median: 44) years ( Table). The lymphadenopathy appeared 1 day after the first vaccine dose, and it is in resolution, with significant reduction in size since onset.ī. Supraclavicular lymphadenopathy ipsilateral to the vaccination arm (left), COVID-19 vaccination, Spain, 2021Ī.
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