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du Preez HN, Lin J, Maguire GEM, Aldous C, Kruger HG. COVID-19 vaccine adverse events: Evaluating the pathophysiology with an emphasis on sulfur metabolism and endotheliopathy. Eur J Clin Invest 2024:e14296. [PMID: 39118373 DOI: 10.1111/eci.14296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 07/24/2024] [Indexed: 08/10/2024]
Abstract
In this narrative review, we assess the pathophysiology of severe adverse events that presented after vaccination with DNA and mRNA vaccines against COVID-19. The focus is on the perspective of an undersulfated and degraded glycocalyx, considering its impact on immunomodulation, inflammatory responses, coagulation and oxidative stress. The paper explores various factors that lead to glutathione and inorganic sulfate depletion and their subsequent effect on glycocalyx sulfation and other metabolites, including hormones. Components of COVID-19 vaccines, such as DNA and mRNA material, spike protein antigen and lipid nanoparticles, are involved in possible cytotoxic effects. The common thread connecting these adverse events is endotheliopathy or glycocalyx degradation, caused by depleted glutathione and inorganic sulfate levels, shear stress from circulating nanoparticles, aggregation and formation of protein coronas; leading to imbalanced immune responses and chronic release of pro-inflammatory cytokines, ultimately resulting in oxidative stress and systemic inflammatory response syndrome. By understanding the underlying pathophysiology of severe adverse events, better treatment options can be explored.
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Affiliation(s)
- Heidi N du Preez
- Catalysis and Peptide Research Unit, University of KwaZulu-Natal, Durban, South Africa
- College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Johnson Lin
- School of Life Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Glenn E M Maguire
- Catalysis and Peptide Research Unit, University of KwaZulu-Natal, Durban, South Africa
- School of Chemistry and Physics, University of KwaZulu-Natal, Durban, South Africa
| | - Colleen Aldous
- College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Hendrik G Kruger
- Catalysis and Peptide Research Unit, University of KwaZulu-Natal, Durban, South Africa
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Parikh R, Feigin KN, Sevilimedu V, Huayanay J, Pinker K, Horvat JV. Comparison of Axillary Lymph Nodes on Breast MRI Before and After COVID-19 Booster Vaccination. Acad Radiol 2024; 31:755-760. [PMID: 37037711 PMCID: PMC10017388 DOI: 10.1016/j.acra.2023.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/08/2023] [Accepted: 03/10/2023] [Indexed: 03/18/2023]
Abstract
RATIONALE AND OBJECTIVES Vaccine-related lymphadenopathy is a frequent finding following initial coronavirus disease 2019 (COVID-19) vaccination, but the frequency after COVID-19 booster vaccination is still unknown. In this study we compare axillary lymph node morphology on breast MRI before and after COVID-19 booster vaccination. MATERIALS AND METHODS This retrospective, single-center, IRB-approved study included patients who underwent breast MRI between October 2021 and December 2021 after the COVID-19 booster vaccination. The axillary lymph node with the greatest cortical thickness ipsilateral to the side of vaccination was measured on MRI after booster vaccination and before initial COVID-19 vaccination. Comparisons were made between patients with and without increase in cortical thickness of ≥ 0.2 cm. Continuous covariates were compared using Wilcoxon rank-sum test and categorical covariates were compared using Fisher's exact test. Multiple comparison adjustment was made using the Benjamini-Hochberg procedure. RESULTS All 128 patients were included. Twenty-four of 128 (19%) displayed an increase in lymph node cortical thickness of ≥ 0.2 cm. Patients who received the booster more recently were more likely to present cortical thickening, with a median of 9 days (IQR 5, 20) vs. 36 days (IQR 18, 59) (p < 0.001). Age (p = 0.5) and type of vaccine (p = 0.7) were not associated with thickening. No ipsilateral breast cancer or malignant lymphadenopathy were diagnosed on follow-up. CONCLUSION Axillary lymphadenopathy on breast MRI following COVID-19 booster vaccination is a frequent finding, especially in the first 3 weeks after vaccination. Additional evaluation or follow-up may be omitted in patients with low concern for malignancy.
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Affiliation(s)
- Rooshi Parikh
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 300 E 66th St., New York, NY 10065, USA; The City University of New York (CUNY) School of Medicine, New York, New York
| | - Kimberly N Feigin
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 300 E 66th St., New York, NY 10065, USA
| | - Varadan Sevilimedu
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jorge Huayanay
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 300 E 66th St., New York, NY 10065, USA
| | - Katja Pinker
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 300 E 66th St., New York, NY 10065, USA
| | - Joao V Horvat
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 300 E 66th St., New York, NY 10065, USA.
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Ozcan C, Dag A, Arslan B, Ozcan PP, Ustun RO, Turkegun M. Axillary Lymph Nodes in Breast Cancer Patients After COVID-19 Vaccine. Indian J Surg 2023:1-6. [PMID: 37361395 PMCID: PMC10181920 DOI: 10.1007/s12262-023-03804-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 05/01/2023] [Indexed: 06/28/2023] Open
Abstract
One of the side effects of vaccines used to end the COVID-19 epidemic is non-specifically enlarged axillary lymph nodes. Such lymphadenopathy detected during clinical examination of breast cancer patients may require additional imaging or interventional procedures that should not normally be performed. This study has been designed to estimate the incidence of palpable enlarged axillary lymph node in breast cancer patients who had received COVID-19 vaccination in the past 3 months in the same arm as compared to those without vaccination. Breast cancer patients admitted to M.U. Medical Faculty Breast polyclinic between January 2021 and March 2022 were screened, and clinical staging was performed after thorough clinical examination. Among these patients with suspected enlarged axillary lymph node and those undergoing sentinel lymph node biopsy (SLNB), they were divided into two groups as vaccinated and unvaccinated. Age, menopausal status, tumor size, tumor location, surgery, pathology results, hormonal receptor status, and SLNB results were statistically compared with groups. There was no significant difference between groups in terms of age, menopause, tumor size, tumor location, surgery, pathological results, and hormone receptor status. The SLNB being reported as reactive only was 89.1% in the vaccinated group and 73.2% in the non-vaccinated group which was statistically significant different. Reactive lymph nodes were commonly found with an excess of 16% in patients who had received COVID-19 vaccination in the past 3 months. This required caution and additional examination of the axillary lymph nodes in this period.
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Affiliation(s)
- Cumhur Ozcan
- Department of General Surgery, Medical Faculty of Mersin University, Mersin, Turkey
| | - Ahmet Dag
- Department of General Surgery, Medical Faculty of Mersin University, Mersin, Turkey
| | - Bilal Arslan
- Department of General Surgery, Medical Faculty of Mersin University, Mersin, Turkey
| | - Pınar Pelin Ozcan
- Department of Nuclear Medicine, Medical Faculty of Mersin University, Mersin, Turkey
| | - Recep Okan Ustun
- Departman of Plastic Reconstructive and Aesthetic Surgery, Mersin City Training and Research Hospital, Mersin, Turkey
| | - Merve Turkegun
- Department of Biostatistics and Medical Informatics, Medical Faculty of Mersin University, Mersin, Turkey
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Sardanelli F, Colarieti A. Imaging of axillary lymph nodes in the COVID-19 era: A lesson to be learned. Eur J Radiol 2022; 154:110446. [PMID: 35917755 PMCID: PMC9301931 DOI: 10.1016/j.ejrad.2022.110446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 07/18/2022] [Indexed: 11/10/2022]
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Aleman RT, Rauch J, Desai J, Chaiban JT. COVID-19 Vaccine-Associated Lymphadenopathy in Breast Imaging Recipients: A Review of Literature. Cureus 2022; 14:e26845. [PMID: 35974844 PMCID: PMC9375123 DOI: 10.7759/cureus.26845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2022] [Indexed: 11/30/2022] Open
Abstract
The unpredictability of the coronavirus disease 2019 (COVID-19) pandemic has created an ongoing global healthcare crisis. Implementation of a mass vaccination program to accelerate disease control remains in progress. Although injection site soreness, fatigue, and fever are the most common adverse reactions reported after a COVID-19 vaccination, ipsilateral lymph node enlargement has increasingly been observed. In patients undergoing routine screening and surveillance for breast cancer, interpreting lymphadenopathy (LAP) is challenging in the setting of a recent COVID-19 vaccination. With a growing proportion of the population receiving the vaccine, a multifaceted approach is necessary to avoid unnecessary and costly workup. In this comprehensive review, we summarize the existing literature on COVID-19 vaccine-associated LAP in breast imaging patients.
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Yoshimoto N, Yanagi A, Takayama S, Sakamoto M, Tomoda K, Ishikawa K, Kawate A, Takayama S, Yamashita M, Yamamoto S, Yokoyama K, Suzuki H, Kani H. Axillary Lymph Node Swelling After COVID-19 Booster Vaccination: Japanese Case Report and Literature Review. In Vivo 2022; 36:1977-1981. [PMID: 35738594 PMCID: PMC9301409 DOI: 10.21873/invivo.12921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/21/2022] [Accepted: 05/24/2022] [Indexed: 11/10/2022]
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.
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Affiliation(s)
- Nobuyasu Yoshimoto
- Department of Breast Surgery, Nagoya Tokushukai General Hospital, Kasugai, Japan;
- Clinical Research Center, Nagoya Tokushukai General Hospital, Kasugai, Japan
| | - Akemi Yanagi
- Department of Radiology, Nagoya Tokushukai General Hospital, Kasugai, Japan
| | - Satoru Takayama
- Department of Surgery, Nagoya Tokushukai General Hospital, Kasugai, Japan
| | - Masaki Sakamoto
- Department of Surgery, Nagoya Tokushukai General Hospital, Kasugai, Japan
| | - Keisuke Tomoda
- Department of Surgery, Nagoya Tokushukai General Hospital, Kasugai, Japan
| | - Ken Ishikawa
- Department of Surgery, Nagoya Tokushukai General Hospital, Kasugai, Japan
| | - Akifumi Kawate
- Department of Surgery, Nagoya Tokushukai General Hospital, Kasugai, Japan
| | - Shoryu Takayama
- Department of Surgery, Nagoya Tokushukai General Hospital, Kasugai, Japan
| | | | - Shinya Yamamoto
- Department of Surgery, Nagoya Tokushukai General Hospital, Kasugai, Japan
| | - Kioto Yokoyama
- Department of Surgery, Nagoya Tokushukai General Hospital, Kasugai, Japan
| | - Hiroto Suzuki
- Department of Surgery, Nagoya Tokushukai General Hospital, Kasugai, Japan
| | - Hisanori Kani
- Department of Surgery, Nagoya Tokushukai General Hospital, Kasugai, Japan
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Time for Resolution of COVID-19 Vaccine-Related Lymphadenopathy and Associated Factors. AJR Am J Roentgenol 2022; 219:559-568. [PMID: 35583425 DOI: 10.2214/ajr.22.27687] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background. The variable clinical course of subclinical lymphadenopathy detected on breast imaging after COVID-19 vaccination creates management challenges and has led to evolving practice recommendations. Objective. To assess the duration of axillary lymphadenopathy ipsilateral to COVID-19 vaccination detected by breast imaging and to assess factors associated with the time until resolution. Methods. This retrospective single-center study included 111 patients (mean, 52±12 years) with unilateral axillary lymphadenopathy ipsilateral to Pfizer or Moderna COVID-19 vaccine administration performed within the prior 8 weeks that was detected on breast ultrasound performed between January 1st, 2021, and October 1st, 2021 and that underwent follow-up ultrasound examinations at 4-12 week intervals until resolution of the lymphadenopathy. Patient information was extracted from medical records. Cortical thickness of the largest axillary lymph node on ultrasound was retrospectively measured and was considered enlarged when greater than 3 mm. Multivariable linear regression analysis was used to identify independent predictors of the time until resolution. Results. The mean cortical thickness on the initial ultrasound was 4.7±1.2 mm. The lymphadenopathy resolved a mean of 97±44 days after the initial ultrasound and 127±43 days after the first vaccine dose, as well as after a mean of 2.4±0.6 follow-up ultrasound examinations. Significant independent predictor of shorter time to resolution was Pfizer (rather than Moderna) vaccination [coefficient=-18.0 (95% CI: -34.3, -1.7); p=.03], and significant independent predictors of longer time to resolution were receipt of the second dose after the initial ultrasound [coefficient=19.2 (95% CI: 3.1, 35.2); p=.02] and greater cortical thickness on the initial ultrasound [coefficient=8.0 (95% CI: 1.5, 14.5); p=.02]. Patient age, prior history of breast cancer, and axillary symptoms were not significantly associated with time to resolution (all p>.05). Conclusion. Axillary lymphadenopathy detected by breast ultrasound after COVID-19 mRNA vaccination lasts longer than reported in initial vaccine clinical trials. Clinical Impact. The prolonged time for resolution supports not delaying screening mammography due to recent COVID-19 vaccination as well as the recent professional society recommendation of a follow-up interval of at least 12 weeks for suspected vaccine-related lymphadenopathy.
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COVID-19 Vaccination and Subclinical Axillary Lymphadenopathy on Mammogram: Correspondence. Acad Radiol 2022; 29:633. [PMID: 35058134 PMCID: PMC8710395 DOI: 10.1016/j.acra.2021.12.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 12/17/2021] [Accepted: 12/22/2021] [Indexed: 12/02/2022]
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