接種新型冠狀病毒疫苗後出現頸部淋巴結腫大並持續發燒的一病例報告

A Case with Enlarged Cervical Lymph Nodes and Persistent Fever after COVID-19 Vaccination

本報告描述一位76歲女性，於接種莫德納新型冠狀病毒messenger RNA疫苗2週內，陸續出現發燒、意識改變與行走困難等症狀，檢查發現多處淋巴結及脾臟腫大，伴隨血小板減少，在排除疫苗相關併發症-疫苗誘發血栓性血小板低下症候群（vaccine induced thrombotic thrombocytopenia）後，多次評估從不同途徑進行組織切片，但因病灶位置較深、且鄰近重要血管，切片皆未成功，而後病人出現噬血細胞性淋巴組織細胞增生症（hemophagocytic lymphohistiocytosis），最終透過頸部淋巴結切除手術，確診為瀰漫性大B細胞淋巴瘤（diffuse large B-cell lymphoma）。本病例強調疫苗接種後，若持續出現多種非特異性表現，需警覺惡性腫瘤的可能性，以早期診斷治療。

This is a 76-year-old woman who developed fever, altered consciousness, and gait disturbance within two weeks after receiving a Moderna COVID-19 messenger RNA vaccine. Imaging revealed multiple enlarged lymph nodes and splenomegaly, accompanied by thrombocytopenia. After excluding vaccine-induced thrombotic thrombocytopenia as a possible vaccine-related complication, several attempts were made to obtain tissue samples through different approaches. However, all biopsies were unsuccessful due to the deep location of the lesions and their proximity to major blood vessels. The patient subsequently developed hemophagocytic lymphohistiocytosis and was ultimately diagnosed with diffuse large B-cell lymphoma following excisional biopsy of cervical lymph nodes. This case highlights the importance of considering underlying malignancy in patients who develop persistent, nonspecific symptoms following vaccination, to facilitate early diagnosis and timely treatment.