Informed consent for publication of this case was obtained from the patient. The supraclavicular lymph nodes were smaller in size and also cortex thickness had decreased. We performed a control sonography examination 1.5 months after the second episode and complete resolution of the focal eccentric thickening of the carotid wall was confirmed (Figure 3). He used the NSAIDs prescribed in the previous episode, and his symptoms resolved gradually in about two weeks. Two months later, he had his second dose of mRNA vaccine, and he had a recurrence of his symptoms. The patient was given non-steroidal anti-inflammatory drugs (NSAIDs) (dexketoprofen 50 mg per day for five days) and his symptoms resolved gradually in 10 days. The largest lymph node measured 9.1×4.7 mm in size, and the widest cortex thickness was 3.3 mm (Figure 2). Three lymph nodes, which were oval-shaped with preserved fatty hilus and asymmetric cortical thickening, were noted in the left supraclavicular region. No cervical lymphadenopathy was detected. No hemodynamic alterations or narrowing of the carotid artery lumen was seen. Sonography revealed focal eccentric thickening of the carotid wall (adventitial thickening) at the bulbous and proximal internal and external carotid arteries and increased echogenicity of perivascular fat tissue (Figure 1). Sonography examination was performed with Sonoline Antares S2000 (Siemens Medical Solutions, Erlangen, Germany) system using 13-5 MHz and 9MHz high-resolution linear transducers. The patient was referred to our radiology department for sonography. The patient had a history of mRNA-based Pfizer-BioNTech COVID-19 (BNT162b2) vaccine administered in the left arm one week before the onset of pain. Control sonography examination 1.5 months after the 2nd episode shows complete resolution of the focal eccentric thickening of the carotid wall and increased echogenicity of perivascular fat tissue.Ī 39-year-old man with left-sided neck pain, who was exacerbated by head movements and swallowing for the last 20 days, presented to our outpatient otorhinolaryngology (ear, nose, and throat ) department. We describe a case of recurrent TIPIC syndrome and supraclavicular lymphadenopathy following the ipsilateral mRNA-based COVID-19 vaccine. Monitoring adverse reactions following immunization is essential, particularly for novel vaccines such as those against COVID-19. Recently it has been recognized among the complications of COVID-19 (9-11). TIPIC syndrome due to chemotherapy, Burkitt’s lymphoma, high-altitude traveling, fluoxetine use, heralding the onset of acute leukemia, and following flu-like illness has been reported (3-8). The etiology of the syndrome is not clear yet. The most common appearance is the existence of focal eccentric thickening of the carotid wall and abnormal soft tissue surrounding the carotid artery, especially near the bifurcation and usually without any hemodynamic alterations (1, 2). Recently, characteristic imaging findings were classified (1). T ransient perivascular inflammation of the carotid artery (TIPIC) syndrome is a rare disease. Keywords: TIPIC syndrome, supraclavicular lymphadenopathy, COVID-19 vaccine Introduction We describe a case of recurrent transient perivascular inflammation of the carotid artery (TIPIC) syndrome and associated supraclavicular lymphadenopathy after ipsilateral intramuscular administration of an mRNA-based COVID-19 vaccine. This work is licensed under a Creative Commons Attribution-Non Commercial 4.0 International License. Subacute and recurrent transient perivascular inflammation of the carotid artery (TIPIC syndrome) and supraclavicular lymphadenopathy associated with ipsilateral intramuscular m-RNA COVID-19 vaccine.
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