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