Abstract | May 6, 2021

Post-COVID Lymphadenopathy in Patient with Remote COVID-19 Infection

Presenting Author: Chelsey Danielle Stewart, DO, Internal Medicine Resident PGY-1, Graduate Medical Education - Internal Medicine, Magnolia Regional Healthcare Center, Corinth, Ms

Coauthors: M. Hayes Baker, MD, Program Director of Internal Medicine Residency, MRHC

Learning Objectives

  1. Lymphadenopathy, especially hilar lymphadenopathy, can be an imaging finding associated with COVID-19.
  2. Lymphadenopathy could develop or persist well after the patient has recovered from COVID-19 and is not just associated with cases of severe COVID-19 infection as once speculated.
  3. Further investigation is needed to determine the relevance of lymphadenopathy in COVID-19 and if it plays a role in the overall disease process.

Computed tomography (CT) is an informative tool in the diagnosis of COVID-19. Common CT imaging findings include bilateral ground-glass opacities and peripheral air space opacities. A more infrequent finding is lymphadenopathy. While rare, lymphadenopathy, especially hilar lymphadenopathy, has been reported on CT imaging of COVID-19 patients. Speculation has arisen as to this finding being isolated to severe cases of the disease. In this case report, we will discuss post-COVID lymphadenopathy in a 26 year-old female who was diagnosed with COVID-19, not requiring hospitalization, approximately 4 months prior to imaging findings.

Case Presentation:
Patient is a 26 year-old female with past medical history of chronic sinusitis, pre-diabetes mellitus, morbid obesity, depression, and anxiety who initially presented with left lower abdominal pain that radiated into her lower back. Patient reported her pain was a 7/10 in intensity. She also reported associated subjective fever. On presentation vital signs were unremarkable except for patient’s blood pressure which was elevated at 172/82. Significant laboratory findings included a WBC of 10.9, AST 103, ALT 207, and an alkaline phosphatase of 354. CT of the chest/abdomen/pelvis was obtained which showed hilar and mediastinal lymphadenopathy as well as unchanged hepatomegaly from May of 2019, but newly identified splenomegaly. Recommended follow-up PET-CT confirmed pathologically enlarged hypermetabolic lymph nodes in the neck, chest, and abdomen as well as hypermetabolic lymphoid tissue in the palatine tonsils and adenoid tissue. Differential diagnosis at this time included lymphoma versus sarcoidosis.

Final/Working Diagnosis:
Initial tissue sampling was attempted by bronchoscopy, but the tissue obtained did not appear to accurately represent the cell population present. An ultrasound guided biopsy was then performed on the right submandibular lymph node. Flow cytometry did not detect any clonal B-cells or any atypical T-cell population. These results along with the pathological examination confirmed the sample consisted of lymphoid tissue with reactive hyperplasia.

A repeat CT scan will be obtained in 6 months to ensure resolution of lymphadenopathy. It is important to note this occurrence and that lymphadenopathy could be an associated finding on imaging well after the patient has recovered from COVID-19.