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Covid-19 and Enlarged Lymph Nodes

The Covid-19 pandemic has well and truly changed our lives for the last two years. Public health measures such as social distancing, mask-wearing and mass vaccination have now become a new way of life for most of us. While we bemoan a lot of the inconveniences and disruptions that come with these measures, another health-related matter has been observed to be on the rise. I’m referring to the presence of enlarged lymph glands.

Lymph glands or nodes are distributed all over our body. They are part of our immune system which helps to combat infections. When that happens, these lymph nodes can become abnormally enlarged and palpable especially when they are located close to the skin surface. Common areas of our body to feel for abnormal lymph nodes include the neck region, the armpits (or axilla) and the groin. Normal lymph nodes should not be palpable. For some individuals however, normal lymph nodes can still be felt as mobile pea-sized nodules under the skin. When lymph nodes enlarge to approximately the size of an M&M or a peanut, this should be of sufficient concern to seek a consultation with your doctor.

Recent medical literature has reported many cases of enlarged lymph nodes following vaccination with the Pfizer-BioNTech and Moderna Covid-19 vaccines. Although the incidence remains low at around 1% of vaccinated patients, this complication has been reported to occur within two weeks after the first vaccine dose and within days of completing the second vaccine dose.

While the patient may report other vaccine complications such as fever, muscle aches and sores, general malaise and even rashes, the presence of enlarged lymph nodes poses a particular challenge for patients who have a history of cancer. This is because enlarged lymph nodes are often an early sign of a relapse for cancers involving the breast, thyroid, and lung. Lymph nodes around the neck is also a common presenting symptom for most head and neck cancers, lymphoma and tuberculosis (TB).

A 31-year-old healthy female recently came to see me with an enlarged lymph node in the right side of her neck. This was observed a few days after the completion of her second covid-19 vaccination. It bothered her because it was quite clearly visible and tender to touch. Lying on the affected side of the neck was painful. After seeing her family doctor and completing a course of oral antibiotics, the swelling did not subside.

When I examined her neck, the tender mass measured approximately 3cm. It was important to examine all the other common sites for lymph node enlargement to ensure she did not have other similarly abnormal lymph nodes. Examination of her oral cavity and a nasoscope examination were performed to ensure there were no underlying occult malignancies or infections. Finally, a bedside ultrasound was performed to evaluate the enlarged lymph nodes as well as the rest of the neck. A fine needle biopsy was performed on the spot. This is the best test to differentiate between a non-cancerous or a cancerous node because of its minimally invasive, non-surgical nature. In addition, it is a reliable and rapid evaluation, is cheaper than surgery and is generally well-tolerated by the patient. Fortunately, the final biopsy result was re-assuring and negative for malignancy.

 

Dotted area outlines the enlarged lymph nodes

Ultrasound of the enlarged lymph nodes
 

In general, the constant wearing of masks for the better part of the last two years has resulted in many more patients presenting with cases of unexplained enlarged lymph nodes in the neck. This is an anecdotal observation by many of my colleagues that has not been reported in the medical literature.

My advice to the general public: do not neglect any unusual neck lumps that may have suddenly appeared in recent times. Seek a consultation with your doctor for a peace of mind.

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