A 66-year-old man with no significant medical history except for hypertension, hypercholesterolemia, and type 2 diabetes presented on September 1, 2021, with lymph node enlargement on his neck. The increase in size became apparent after a recent flu-like syndrome. He has no history of cancer.
He had two doses of BNT162b2 mRNA vaccine (Pfizer) 5 and 6 months earlier in the left shoulder (deltoid muscle). He had a moderate weakness but did not report any constitutional symptoms like fever, poor appetite, or headache.
He went to see a doctor, and an initial blood examination showed a mild inflammatory syndrome. The rest of the blood tests were unremarkable. A PET scan was done to see if there are cancer cells, and the first one is shown below. The large black areas in the head and pelvic areas are the brain and urinary bladder, which are expected and not concerning.
The smaller black spots in the neck, near the armpits, the abdomen are swollen lymph nodes. A lymphoma, a cancer of the lymphatic system, will look like this on a PET scan. Some of the lymphomas have spread outside the lymphatic system. These are problematic and suggestive of Stage IV lymphoma.
A biopsy of a lymph node from the neck was done. Detailed testing of the lymph node showed AngioImmunoblastic T cell Lymphoma (AITL). According to the Lymphoma Research Foundation,
Angioimmunoblastic T-cell lymphoma (AITL) is a rare, often but not always, aggressive (fast-growing) form of peripheral T-cell lymphoma (PTCL). While AITL only accounts for one to two percent of all NHL cases in the United States, it is one of the more common subtypes of T-cell lymphomas. Elderly patients are more likely to be diagnosed with AITL.
A Pfizer booster shot was given 14 days after the first PET scan in the right deltoid to prepare for chemotherapy. A few days after the jab, the patient reported that the lymph nodes on the right side of his neck got bigger.
A second PET scan was done to provide a baseline PET scan nearest to chemotherapy, eight days after the booster and 22 days after the first one.
The PET scans are compared below—the before (left) and after (right) the Pfizer booster shot.
Note the dramatic increase in the lymph nodes and gastrointestinal area lesions on the right image. These are hypermetabolic lymphomas that are growing fast. The metabolic progression is more pronounced on the right side of the neck, above the collar bone, and armpit areas—the same side where the booster shot was given. (The right side of the patient is on your left side). New lymphomas are also visible.
The Total lesion glycolysis (TLG) index was used to assess the changes in lymph node metabolism. The authors note,
As compared with the initial test, there was a marked 5.3-fold increase in whole-body TLG, with the increase in the post-booster test being twice higher in the right axillary region than in the left one.
Treatment was immediately started, and the patient improved. The authors say,
At the time of this report, 2 weeks after start of the treatment, clinical examination indicates significant decreased swelling of cervical and axillary lymph nodes, and the overall performance status of the patient is improving.
Has this happened before?
The authors mentioned that several reports had been made of lymph node enlargement after the Pfizer-BioNTech, Moderna, and AstraZeneca. Some of the lymph node enlargement and hyperreactivity were non-cancerous.
Is the lymphoma progression related to the Pfizer booster?
The authors point out the rapid progression of the AITL, the asymmetric increase in the right side where the booster shot was given, and the new lesions that developed after the vaccine argue for the Pfizer shot to be the cause of the progression of the AITL.
What’s the scientific explanation?
Previous studies on animals and humans have shown that mRNA gene therapy shots have induced the growth of T follicular helper cells (TFH) within the germinal centers of the tonsil, spleen, and lymph nodes. TFH cells help the B cells produce antibodies which is the goal of the mRNA shots.
Malignant T Follicular Helper cells with the RHOA G17V and TET2 mutations present in this patient might be especially sensitive to mRNA vaccines.
The authors do not recommend further COVID vaccination for the patient presented here. The case report was peer-reviewed and published in Frontiers in Medicine.
Take Away Message
Anyone who feels an enlargement of a lymph node, especially if it is associated with weakness, fever, and poor appetite, should consult their physician.
The photo below shows the locations where lymph nodes are located. The palpable lymph nodes are in front of the ears (pre-auricular), around the neck (cervical), above the collar bone (supraclavicular), armpit areas (axillary), opposite the elbow (epitrochlear and brachial), and the groin (inguinal and femoral)—any persistent enlargement of those needs medical attention.
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Reference:
Goldman, Serge et al. “Rapid Progression of Angioimmunoblastic T Cell Lymphoma Following BNT162b2 mRNA Vaccine Booster Shot: A Case Report.” Frontiers in medicine vol. 8 798095. November 25, 2021, doi:10.3389/fmed.2021.798095
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