PDF(Pubmed)
Abstract：
Pfizer/BioNTech (BNT162b2) is a messenger RNA (mRNA) vaccine that is highly effective in preventing the most severe outcomes of COVID-19 infection. Nucleoside-modified severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA vaccines induce effective stimulation of T follicular helper (TFH) cells, leading to a robust germinal center B cell response. Side effects from the BNT162b2 vaccination, including significant lymphadenopathy, have been reported previously. Here, we present a case of angioimmunoblastic lymphoma (AITL), a rare, peripheral T-cell lymphoma with RHOA-G17v-mutated gene developing in a patient following BNT162B2 vaccine with a plausible explanation. A 60-year-old Asian female received her first dose of Pfizer BNT162B2 mRNA vaccine in August 2021. Right after her vaccination, she developed right axillary lymphadenopathy. She received her second vaccine dose in September 2021. Thereafter, she developed lymph node (LN) enlargement in her neck and groin. She underwent left posterior cervical and left groin LN excisional biopsy in April 2022 due to persistent palpable lymphadenopathy. Biopsy results then demonstrated benign follicular hyperplasia. For progressive B symptoms, a right axillary LN biopsy was done, which demonstrated AITL, with molecular studies revealing mutation in TET-2, IDH-2, and RHOA-G17v genes. Progression of AITL following BNT162B2 mRNA vaccine is limited in literature. Our case demonstrates a plausible correlation between the diagnosis of AITL following mRNA vaccination due to the malignant transformation of the TFH cells in patients who have a predisposing mutation of RHOA-17v. Given the rarity of AITL and the heterogeneity of molecular findings, more studies are needed to establish such an association.
摘要：
Pfizer/BioNTech（BNT162b2）是一种信使RNA（mRNA）疫苗，可有效预防COVID-19感染的最严重后果。核苷修饰的严重急性呼吸综合征冠状病毒2（SARS-CoV-2）mRNA疫苗诱导有效刺激T滤泡辅助（TFH）细胞，导致强大的生发中心B细胞反应。BNT162b2疫苗接种的副作用，包括明显的淋巴结病，以前有报道。这里,我们介绍了一例血管免疫母细胞淋巴瘤（AITL），一种罕见的，1例BNT162B2疫苗接种后患者出现RHOA-G17v突变基因的外周T细胞淋巴瘤,并给出合理的解释.一名60岁的亚洲女性在2021年8月接受了她的第一剂辉瑞BNT162B2mRNA疫苗。就在她接种疫苗后，她出现了右腋窝淋巴结肿大。她于2021年9月接受了第二剂疫苗。此后,她的颈部和腹股沟出现淋巴结（LN）肿大。2022年4月，由于持续的可触及淋巴结肿大，她接受了左颈椎后路和左腹股沟LN切除活检。然后活检结果显示良性滤泡增生。对于进行性B症状，做了右腋窝LN活检,这证明了AITL，分子研究揭示了TET-2，IDH-2和RHOA-G17v基因的突变。BNT162B2mRNA疫苗后AITL的进展在文献中是有限的。我们的病例表明，由于具有RHOA-17v易感突变的患者TFH细胞的恶性转化，mRNA疫苗接种后AITL的诊断之间存在合理的相关性。鉴于AITL的稀有性和分子研究结果的异质性，需要更多的研究来建立这样的关联。
