Lymphoma patient develops CAD after receiving COVID-19 vaccine
Case report: Post-vaccination illness led to underlying blood cancer diagnosis
A man developed cold agglutinin disease (CAD) shortly after receiving a COVID-19 vaccine, which ultimately led to the diagnosis of an underlying blood cancer known as diffuse large B-cell lymphoma (DLBCL), according to a recent case report.
While COVID-19 vaccines are considered safe and effective, the authors emphasized the importance of monitoring for rare adverse events, particularly in individuals with undiagnosed or predisposing conditions.
The case report, “Cold Agglutinin Autoimmune Hemolytic Anemia Revealing Undiagnosed Diffuse Large B-cell Lymphoma Following COVID-19 Vaccination,” was published in Cureus.
Symptoms began week after vaccination
CAD is a form of autoimmune hemolytic anemia, a group of disorders in which the immune system mistakenly attacks and destroys the body’s own red blood cells. In CAD, self-reactive antibodies, known as cold agglutinins, bind to red blood cells at low temperatures — typically below normal body temperature. This binding causes the red blood cells, which carry oxygen throughout the body, to clump together, or agglutinate, and be destroyed, leading to hemolytic anemia.
In most cases, CAD is associated with an underlying condition such as infections, other autoimmune diseases, or certain cancers, including lymphomas.
In this report, researchers described the case of a 56-year-old man who sought medical attention due to generalized weakness, loss of appetite, night sweats, and a 10-pound weight loss in one month. The man reported his symptoms started one week after receiving a booster vaccine for COVID-19.
He had a history of vitiligo, an autoimmune skin condition, and Graves’ disease, an autoimmune disorder affecting the thyroid.
A physical exam showed he had pale skin and jaundice, or yellowing of the skin and the whites of the eyes. Blood tests revealed anemia, meaning he had too few red blood cells. The tests also showed low haptoglobin and high levels of bilirubin, lactate dehydrogenase, and reticulocytes, all signs that his red blood cells were being destroyed faster than normal.
He also had elevated levels of liver enzymes, inflammation markers, and white blood cells, which can indicate infections or blood cancers. A CT scan revealed an enlargement of the liver and spleen, as well as lymph node swelling close to the liver.
Further testing of the enlarged lymph node, bone marrow, which is the soft tissue inside bones that makes new blood cells, and liver tissue confirmed a diagnosis of DLBCL.
Case highlights potential tie between COVID vaccine, underlying lymphoma
He was first treated with antibiotics in case an infection was causing his symptoms, but this was stopped after tests on his blood, urine, and lungs came back negative. Doctors then tried treating him with corticosteroids, a common treatment for most types of autoimmune hemolytic anemia. However, the steroids did not help, which further supported the diagnosis of CAD, since CAD usually does not respond well to steroids.
While this case highlights a potential association between COVID-19 vaccination, [CAD], and underlying lymphoma, it does not establish causality.
During hospitalization, the patient’s hemoglobin levels further decreased, and he received a blood transfusion. After his condition stabilized, the man was discharged with plans to begin treatments for DLBCL. However, no further medical details were available.
According to the researchers, “it remains uncertain whether the [CAD] was primarily related to the underlying DLBCL or potentially triggered by the immune activation associated with the COVID-19 booster.” CAD has been rarely associated with DLBCL.
“While this case highlights a potential association between COVID-19 vaccination, [CAD], and underlying lymphoma, it does not establish causality,” the researchers wrote. Further studies should address the pathways linking autoimmune conditions with vaccination and cancer, they noted.
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