Injection granuloma mimicking soft tissue sarcoma following seasonal influenza vaccine administration: A case report

Rationale:Soft tissue masses are common within the general population with a minority diagnosed as soft tissue neoplasms. Differing between benign and malignant soft tissue processes can be a challenge given the overlapping clinical and imaging characteristics. We present the case of a 69-year-old female referred to the Orthopaedic Oncology Service for evaluation of a suspected soft tissue sarcoma in the upper arm.Patient Concerns:She reported a mass localized over the deltoid with associated tenderness 1 month after influenza vaccination.Diagnosis:After thorough consideration of the patient's clinical course, history, advanced imaging, and physical examination, the diagnosis of injection granuloma associated with recent influenza vaccination was considered.Interventions:Biopsy was deferred and close interval follow-up with clinical and imaging evaluation revealed a resolving process.Outcomes:The patient was followed until complete resolution of all symptoms, which occurred 5 months after initial presentation.Lessons:It was hypothesized that due the patient's body habitus, the injection contents intended for intramuscular administration remained in the subcutaneous tissues and elicited a granulomatous reaction. This case highlights several important factors for physicians to consider in the work up of suspicious masses for which injection granuloma is on the differential diagnosis.