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Prolonged febrile illness following first dose of ChAdOx1
  1. Michael Caruana Dingli1,
  2. Luke Bugeja2 and
  3. Robert Camilleri3
  1. 1Department of Haematology, Sir Anthony Mamo Oncology Centre, Msida, Malta
  2. 2Department of Gastroenterology, Mater Dei Hospital, Msida, Malta
  3. 3Department of Acute Medicine, Mater Dei Hospital, Msida, Malta
  1. Correspondence to Dr Michael Caruana Dingli; michael.caruana-dingli{at}


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.

  • COVID-19
  • Unwanted effects / adverse reactions
  • Vaccination/immunisation

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  • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content—MCD and LB. The following author gave final approval of the manuscript—RC.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.