[68Ga]Ga-DOTA-TATE uptake due to COVID-19 vaccination.

A 61-year-old female was referred to [68Ga]Ga-DOTA-TATE-PET/CT for suspected neuroendocrine tumor (NET). She suffered from intractable peptic disease, and her chromogranin A had reached a level of 1447 ng/ml. There was a focus of pathological [68Ga]Ga-DOTA-TATE uptake in the head of the pancreas, consistent with NET. There was increased uptake in lymphadenopathy in the left axilla and faint uptake in the left upper arm.

[68]GA-DOTATATE-PET/CT maximal intensity projection (MIP) right anterior oblique view (a) shows focal pathological uptake in the head of the pancreas (dashed circle). Faint uptake in stranding of the subcutaneous fat in the left upper arm is depicted (arrowhead) in an axial slice of fused PET/CT (b), CT (c), PET (d), and MIP (a). Increased uptake in numerous lymph nodes with cortical thickening in the left axilla and retro-pectoral region is depicted (arrow) in an axial slice of fused PET/CT (b), CT (c), PET (d), and MIP (a).

The patient received the second dose of the Pfizer-BioNTech COVID-19 vaccine 2 days prior to the PET/CT, as an intra-muscular shot to the left deltoid. The first dose was administered 21 days prior to the second dose.

Lymphatic tissues including lymph nodes are known to express somatostatin receptors [1], and [68]GA-DOTATATE uptake is commonly seen in reactive lymph nodes [2]. This case demonstrates [68]GA-DOTA-TATE uptake due to COVID-19 vaccination in a pattern identical to that of FDG uptake following COVID-19 vaccination [3, 4]. Nuclear medicine physicians and referring physicians should be aware of this classic pattern. History of recent vaccination localized to the site of uptake should confirm the diagnosis and obliviate the need for further testing.