CASE 17342 Published on 30.06.2021

Post COVID-19 vaccination mastitis

Section

Breast imaging

Case Type

Clinical Cases

Authors

Montoliu Fornas G. MD, PhD¹, Bayo Montoliu M. MD²

1. Radiology department, Hospital Universitario y Politécnico La Fe, Valencia, Spain

2. Facultad de Medicina, Universitat de València, Valencia, Spain

Patient

41 years, female

Categories

Area of Interest Breast ; Imaging Technique Ultrasound, Ultrasound-Colour Doppler

No Procedure ; Special Focus Drugs / Reactions ;

Show more Show less

Download as PDF Print Show related cases Notify admin

Clinical History

A 41-year-old female healthcare professional, monitored due to mammary cysts, with no other relevant medical background. 48 hours after receiving the second dose of the Pfizer-BioNTech COVID-19 vaccine in her left arm, she presents with an inflammatory process in her left breast, which is indurated, red and painful at the physical exploration [1,2] (Fig. 1a).

Imaging Findings

Ultrasound imaging was performed both in the acute phase and after 6 days (control). Initial findings included breast skin thickening and a poorly defined area with structural and echogenicity alterations, as well as oedema surrounding the fatty lobules and occupying the mammary parenchyma (1,2). The cysts that were previously found were also identified. No inflammatory axillary lymph nodes were identified (Fig. 1b and 1c).

The control study showed the alterations had improved greatly, and the breast almost had a normal external and radiological appearance (Fig. 2a, 2b, 2c).

Discussion

The case presents a strong relationship between the inflammatory process and the history of the recent COVID-19 vaccination.

The patient had developed a COVID-19 infection in April 2020 (11 months prior), with mild symptoms such as anosmia and headaches. She did not develop serum immunity.

There have been abundant reports of adverse medical effects in those patients that had previous COVID-19 infection and subsequently are vaccinated, with various types of inflammatory responses, most notably axillar lymphadenopathy and very rarely mastitis [3,4], athough the cases described in the medical literature are related with breastfeeding, [5] and no medical literature has been published regarding mastitis during breastfeeding and concurrent COVID-19 infection or non-lactating mastitis after COVID-19 vaccination.

These processes are included in the inflammatory response we produce against the virus [6,7,8].

The process faded spontaneously in 6 days, only requiring anti-inflammatory and analgesic treatment.

Take-home message

This type of mastitis is a self-limited, aseptic inflammatory process that is immunity-mediated and therefore does not require antibiotic treatment.

Differential Diagnosis List

Post COVID-19 vaccine mastitis

Bacterial mastitis

Breast abscess

Inflammatory breast cancer: focal extension and evolution rule this out

Final Diagnosis

Post COVID-19 vaccine mastitis

References

[1] Kasales, Claudia J. et al. (2014) Nonpuerperal mastitis and subareolar abscess of the breast. American Journal of Roentgenology, 202:133-139 (PMID: 24450694)

[2] Tan H, et al. (2013) Radiological and clinical features of non-puerperal mastitis. The British Journal of Radiology, 86:1024 (PMID: 23392197)

[3] Ahn Richard W et. al, (2021) Axillary Lymphadenopathy after mRNA COVID-19 vaccination.Radiol Cardiothoracic Imaging, 3:1. (PMC7861140). (PMID: 33778667)

[4] Nishi Mehta et al, (2021) Unilateral axillary Adenopathy in the setting of COVID-19 vaccine. Clinical Imaging 75 :12-15. (PMID: 33486146)

[5] Pace, Ryan M, et al, (2021) Characterization of SARS-CoV-2 RNA, Antibodies, and Neutralizing Capacity in Milk Produced by Women with COVID-19. Mbio, 12:1. doi:10.1128/mBio.03192-20 (PMID: 33563823)

[6] Sanaz K et al, (2021) COVID-19 vaccine is here: practical considerations for clinical imaging applications. (76:38-41). DOI:https://doi.org/10.1016/j.clinimag.2021.01.023. (PMID: 33548891)

[7] Pfizer-BioNTech COVID-19 Vaccine; FDA Briefing Document. Vaccines and Related BiologicalProducts Advisory Committee Meeting. December, 10 2020

[8] Local reactions, systemic reactions, adverse events, and serious adverse events: Pfizer-BioNTech COVID-19 vaccine. Centers for Disease Control and Prevention, Centers for Disease Control and Prevention; 13 Dec. 2020. www.cdc.gov/vaccines/ covid-19/info-by-product/pfizer/reactogenicity.html.

Case information

URL:	https://eurorad.org/case/17342
DOI:	10.35100/eurorad/case.17342
ISSN:	1563-4086

License

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Figure 1

Photography. Initial breast appearance showing inflammatory changes and regional cutaneous reddening

Ultrasound. Ill-defined area with altered echotexture, with hyperechogenicity representing infiltrated and inflamed fat lobules, hypoechoic areas in the glandular parenchyma and associated mild skin thickening are seen (arrow)