SESSION TITLE: Unique Inflammatory and Autoimmune Complications of COVID-19 Infections
SESSION TYPE: Rapid Fire Case Reports
PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm
INTRODUCTION: Sarcoidosis is a disorder with multisystem involvement of unclear, and likely multifactorial, etiology. A majority of cases (up to 90%) include lung involvement, and hilar/mediastinal lymphadenopathy is frequently seen. Since the beginning of the COVID-19 pandemic, multiple complications of COVID-19 have been reported. We present a case of a female patient who developed new-onset, biopsy-proven Pulmonary Sarcoidosis after having COVID-19 pneumonia.
CASE PRESENTATION: A forty-eight-year-old female with a past medical history of hypertension presented to the emergency department with a complaint of fever, shortness of breath, and cough. She was subsequently diagnosed with COVID-19 infection/pneumonia. A computed tomography angiogram of the chest was completed to evaluate an abnormal chest radiograph and to rule out pulmonary embolism and revealed pulmonary nodules throughout both lungs with mediastinal and hilar lymphadenopathy. She was referred to the pulmonary clinic for further evaluation of her abnormal computed tomography scan of the chest and presented after quarantine for her COVID-19 infection. She denied any history of Sarcoidosis and denied any mold exposure. She underwent bronchoscopy, and pathology results were consistent with non-caseating granulomas concerning for Sarcoidosis. Over the course of a few days, her symptoms improved. Repeat computed tomography scan of the chest was completed, which showed complete resolution of the previously identified pulmonary nodules with interval improvement of mediastinal adenopathy.
DISCUSSION: With the increased number of COVID-19 cases worldwide, an ever-growing list of pulmonary and extrapulmonary manifestations of COVID-19 have been reported. To our knowledge based on literature review, there have only been a few case reports of COVID-19 induced Sarcoidosis. Although the pathophysiology of Sarcoidosis largely remains unknown, inflammation is mediated through the dysregulation of several different cytokines (1). Behbahani, et al. proposed noncaseating granulomas formation as a sarcoid-like immune reaction to SARS-CoV-2. Ekinci et al. reported type-I IFN and IFN-γ role in triggering granuloma formation (2). In our patient, the biopsy-proven presence of non-caseating granuloma formation and subsequent rapid improvement of radiological lesions on computed tomography scan after recovery from COVID-19 pneumonia supports the diagnosis of COVID-19 induced Sarcoidosis.
CONCLUSIONS: With the COVID-19 pandemic ongoing, physicians must be aware of the pulmonary and extrapulmonary manifestations of COVID-19 infection. Further studies are required in order to manage such cases and to evaluate COVID-19 infection as an infectious antigen capable of triggering granulomatous inflammation resulting in Pulmonary Sarcoidosis.
Reference #1: Capaccione KM, McGroder C, Garcia CK, Fedyna S, Saqi A, Salvatore MM. COVID-19-induced pulmonary sarcoid: A case report and review of the literature. Clin Imaging. 2022;83:152-158. doi:10.1016/j.clinimag.2021.12.021
Reference #2: Polat Ekinci A, Büyükbabani N, Meşe S, Pehlivan G, Okumuş NG, Ağaçfidan A, Özkaya E. COVID-19-triggered sarcoidal granulomas mimicking scar sarcoidosis. J Eur Acad Dermatol Venereol. 2021 Aug;35(8):e477-e480. doi: 10.1111/jdv.17286. Epub 2021 May 1. PMID: 33871106; PMCID: PMC8250646.
DISCLOSURES: No relevant relationships by Zachary Anderson
No relevant relationships by Sakina Batool
No relevant relationships by Adnan Khan
No relevant relationships by Bireera Muzaffar
No relevant relationships by Ramsha Zafar