Prolonged febrile illness following first dose of ChAdOx1.

A woman in her 40s, with a known history of fibromyalgia, presented with high-grade fever and constitutional symptoms occurring 5 days following vaccination with Oxford-AstraZeneca COVID-19 vaccine (ChAdOx1). Her inflammatory markers and neutrophil count were found to be elevated and as such, she was started on antibiotics. Despite treatment, markers remained elevated and temperature spikes persisted for another 4 weeks before these symptoms subsided, and her blood tests normalised. All investigations taken in the interim were negative, with no source being identified for the fever. As a result, a positron emission tomography scan was performed to attempt to localise the source of these symptoms. This revealed low-to-moderate grade lymph node tracer uptake above and below the diaphragm most pervasive in the right axilla, with uptake in the right arm corresponding with the site of vaccination.

Acquired angioedema: an unusual presentation of haematological malignancy.

A previously healthy man in his 60s being worked up for splenomegaly presented to the emergency department with recurrent episodes of angioedema. Each episode was attributed to a precipitating cause, and consequently, the predisposing C1 esterase inhibitor (C1-INH) deficiency remained undiagnosed until the third presentation. The aetiology of acquired C1-INH deficiency would be primarily obscure and require further investigations to identify. A clonal B cell population was finally isolated by flow cytometry after multiple repeat marrow samples, and a diagnosis of splenic marginal zone lymphoma was subsequently reached. Response to single-agent rituximab was observed with resolution of splenomegaly, disappearance of the antibody and restoration of C1-INH levels.