P46: A case series of COVID-19 vaccination and lymphatic dysfunction

Julian Pearce, Narin Shareef, Bernard Ho and Kristiana Gordon

St George’s University Hospitals NHS Foundation Trust, London, UK

The COVID-19 pandemic and associated vaccination programme has resulted in an explosion of reported cutaneous and vascular presentations. We describe eight cases of lymphoedema either occurring de novo or as a reported worsening of pre-existing lymphatic disease after vaccination against COVID-19. Patients were either referred by other healthcare professionals to our tertiary lymphoedema clinic or, if already know to our service, sought advice from our lymphoedema specialists. Data collected included patient demographics, significant past medical history, vaccine type, inoculated limb, clinical presentation and time of onset of symptoms post dose. All patients were female (mean age 55 years; range 40–73). Four cases occurred after the Pfizer–BioNTech (Comirnaty) vaccine and four after the AstraZeneca vaccine. Five patients had a history of secondary lymphoedema and one had a history of late-onset multisegmental primary lymphoedema without systemic involvement. The remaining two patients had no prior history of lymphoedema. Of the five patients with secondary lymphoedema, four experienced worsening of their swelling within the affected limbs and one experienced de novo swelling affecting the inoculated, contralateral (previously unaffected) limb and trunk. The one patient with primary lymphoedema experienced worsening of their pre-existing swelling. Two patients with no prior history of lymphatic dysfunction developed lymphoedema de novo. All patients with a pre-existing lymphatic abnormality received the vaccine in an unaffected limb. Four presentations occurred solely after the first vaccine dose and three occurred solely after the second dose. One patient experienced repeated flares of lymphatic congestion after each vaccine dose. Lymphoedema has a major impact upon quality of life and management is challenging. These cases contribute to a growing evidence base that lymphatic dysfunction can be associated with COVID-19 vaccination. The Yellow Card Scheme details over 200 reports of lymphoedema associated with COVID-19 vaccination. In comparison to other vaccinations such as the influenza vaccine, where data have been collected over a longer time period, the COVID-19 vaccine appears to have a significantly increased rate of reported associated lymphatic dysfunction. The lymphatic and immune systems develop in concert. A correctly functioning lymphatic system is essential for the generation of a proficient immunological response. The immunological response to COVID-19 vaccination can exacerbate existing lymphatic disease, and in some patients may uncover a previously undetected lymphatic weakness (primary lymphoedema). Our internationally adopted COVID-19 vaccination consensus document aims to provide guidance to patients with lymphatic disorders, along with healthcare professionals, to optimize patient care during vaccination rollout.