Authors:
Kavya Bharathidasan1, Vivie Tran1,
Sayed Ghafouri2, Shabnam Rehman2,
Luis Brandi3
1Department of Internal Medicine, Texas Tech
University Health Science Center, Lubbock, Texas, USA
2Department of Internal Medicine, Division of
Hematology/Oncology, Texas Tech University Health Science Center,
Lubbock, Texas, USA
3Department of Pathology, Texas Tech University Health
Science Center, Lubbock, TX
Corresponding author: Kavya Bharathidasan MD
Department of Internal Medicine, Texas Tech University Health Sciences
Center, Lubbock, Texas, USA
Postal address: 3601 4th St, Lubbock, Texas 79430, USA
Email:
kavya.bharathidasan@ttuhsc.edu
Keywords: metastatic prostate cancer, generalized
lymphadenopathy, COVID vaccine, immunization reaction, prostate
adenocarcinoma
Abstract: Generalized lymphadenopathy is commonly attributed to
infectious causes or malignancy, often lymphoproliferative disorders. We
present a rare case of metastatic prostate cancer diagnosed after
initially presenting as generalized lymphadenopathy following a
coronavirus disease 2019 (COVID) booster vaccination. A 70-year-old
Hispanic male presented with left lower quadrant abdominal pain, nausea,
headache, myalgia, severe constipation, and a right-sided neck swelling
that had been increasing in size since the day of his vaccination.
Computed tomography (CT) scans of soft tissue neck, chest, abdomen, and
pelvis with contrast showed extensive lymphadenopathy. Ultrasound-guided
biopsy results of the enlarged right supraclavicular node and prostate
revealed histopathology consistent with that of prostate acinar
adenocarcinoma. He started on bicalutamide for four weeks, transitioned
to gonadotropin releasing hormone analogue (leuprolide) injections every
3 months and oral androgen receptor signaling inhibitor (abiraterone
with prednisone daily). PSA level declined from 121 ng/mL at diagnosis
to 1.3 ng/mL after 3 months of therapy, and repeat imaging showed marked
improvement in the size of his mediastinal, retroperitoneal, and pelvic
lymphadenopathy. To the best of our knowledge, this is the first case
reported of a COVID vaccine booster uncovering lymphadenopathy leading
to the diagnosis of metastatic prostate cancer.