![]() The authors declare that they have not received funding to carry out this study. With this case report, we aimed to highlight the importance of being aware of the patients’ vaccination history, and that the common presentation of benign reactive lymphadenopathy after vaccination developed against SARS-CoV-2, found also on F-Choline studies, may avoid false positive cases, unnecessary additional imaging and further biopsy procedures, and therefore, other PET tracers should also be taken into consideration. The 23-valent pneumococcal polysaccharide vaccine (PS23) is a vaccine given to protect against infection caused by Streptococcus pneumoniae.Administration of PS23 is indicated in all persons over 64 y and those ages 2 y and older at risk for invasive pneumococcal disease. The authors suggested that the increased tracer uptake reflected a highly activated macrophage burden 3. García Vicente and Soriano Castrejón have described in a patient submitted to a F-Choline PET/CT for assessment of prostate cancer recurrence, findings consistent with COVID-19 pneumonia and with F-Choline uptake. I recently had my covid vaccine - I noticed my shoulder / collarbone was sensitive when I touched it a day after I noticed I had a small, moveable, lump. Therefore, three “time windows” after vaccination have been described, in which the likelihood of depicting non-specific lymph node uptake is lower: over the first 5 days after the first vaccination, on the third week after the first vaccination (before the booster dose is administered), and at least 3 weeks after the booster dose is administered 2. It has been suggested that the imaging study should be postponed through 6 weeks after vaccination, but this recommendation implies also a diagnostic delay that is not acceptable in the oncology setting. The intensity of FDG lymph node uptake overlaps with that of malignant involvement. ![]() In Moderna’s study, 11.6 percent of patients reported swollen lymph nodes. The high rate of lymph nodes with high FDG uptake found in vaccinated patients mean a new challenge on the interpretation of FDG PET/CT studies in oncology patients. We present two clinical cases of lymphadenopathy after vaccination with the human papillomavirus (HPV) 9-valent vaccine: an asymptomatic 11-year-old boy with inferior cervical and supraclavicular lymphadenopathy, and a 13-year-old girl who presented with lymphadenopathy. The swelling in the armpit was a recognized side effect in the large trials of the Moderna and Pfizer-BioNTech vaccines. We therefore considered our imaging findings consistent with reactive lymph nodes, even more so considering the absence of other relevant imaging findings found, and the patient PSA level. ![]() Our patient’s clinical history pointed out that he had received the first dose of SARS-CoV-2 vaccine in his left arm 7 days prior to the imaging study. The reported incidence following the start of mass vaccination in developed countries against SARS-CoV-2 was 36.4% after the first vaccination, and 53.9% after the booster shot 1. Since the coronavirus disease 2019 (COVID-19) outbreak began in December 2019, approximately 220 million patients have been diagnosed to date, with an estimated 4.5 million deaths.
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