Diffuse Large B-Cell Lymphoma Developed Shortly After mRNA COVID-19 Vaccination in a Patient with Sickle Cell Disease: A Chicken-and-Egg Problem

A 26-year-old male with SCD, SS-genotype, who presented with cervical, axillary lymphadenopathy and lower neck mass with compressive symptoms approximately 6-week after encountering COIVD-19 infection that was preceded by receiving a single dose of BNT162b2, COVID-19 mRNA vaccine. True-cut biopsy with immunohistochemistry revealed DLBCL (GCB-subtype). Pan-CT scan with bone marrow biopsy revealed (Stage IIx lymphoma) with good R-IPI. The patient was initially managed by blood transfusion, and methylprednisolone as a pre-phase, followed by six-cycles of R-CHOP-21 without administration of G-CSF. During immunochemotherapy, hydroxyurea was held and alternatively blood transfusion was used whenever indicated. Three years after successful treatment, he is still in persistent complete metabolic remission, despite the diagnostic and therapeutic challenges. To the best of our knowledge, we are the first to report DLBCL in young adult with SCD that developed after BNT162b2 vaccination and COVID-19 infection. A potential causal relationship or an incidental simple association are possible scenarios.