Lofgren syndrome in close temporal association with mild COVID-19 - Case report

Sarcoidosis and COVID-19 Vaccines: A Systematic Review of Case Reports and Case Series

COVID-19 vaccines play a crucial role in preventing complications and alleviating the impact of SARS-CoV-2. Nevertheless, these vaccines have been associated with side effects like pain, fatigue, fever, and, in rare instances, the development of sarcoidosis. This review seeks to provide an overview of research on sarcoidosis occurring after COVID-19 vaccination and attempt to identify potential factors that may contribute to this uncommon yet concerning complication. Our review protocol was registered on PROSPERO with ID: (CRD42023463854). We comprehensively searched five electronic databases (PubMed, Scopus, Web of Science, EMBASE, Cochrane) from August, 22 2023 until September, 1st 2023. We finally had 12 studies after the first and second scans. We used SPSS to analyse the extracted data. We included 31 participants who experienced lung sarcoidosis following COVID-19 vaccination, with 61.3% female, and 38.7% male. The study showed that most events were observed in individuals who got Pfizer-BioNTech or Moderna vaccines, particularly after the second dosage. Pain, local erythema, ulceration or swelling at the injection site, fever, urticaria, pityriasiform rash, and erythema multiforme were some of the most common presenting symptoms. A biopsy was the major diagnostic method. Other modalities were used, including a complete blood count, CT scans, and X-rays. Sarcoidosis has been shown in a limited number of individuals who got the COVID-19 vaccination; however, it is unclear if the vaccine is directly responsible for this condition. However, the COVID-19 vaccines are both safe and effective in preventing the disease, and the advantages of immunisation outweigh any potential risks.

Incidence, management and prognosis of new-onset sarcoidosis post COVID-19 infection

BACKGROUND AND AIM

SARS-CoV-2 infection has been linked to hyperinflammation in multiple organs with a potential mechanistic link with resulting autoimmunity. There have been reports of many inflammatory complications following COVID-19, including sarcoidosis. A literature review on new-onset sarcoidosis following COVID-19 is lacking. We evaluated potential associations between COVID-19 and development of new-onset sarcoidosis.

METHODS

Articles discussing biopsy-proven sarcoidosis after confirmed COVID-19 infection, published 1956 until April 2023, were included. All article types were deemed eligible except opinion and review articles.

RESULTS

A pooled total of 15 patients with new-onset diagnosis of sarcoidosis after COVID-19 infection were included, 45.5% female, mean age 46.1 years (standard deviation 14.7) at onset of sarcoidosis. Patients were from: Europe (n=11); North America (n=2); South America (n=1); Asia (n=1). The mean time between COVID-19 infection and diagnosis of sarcoidosis was 56.3 days, although this ranged from 10 to 140 days. Organ systems predominantly affected by sarcoidosis were: pulmonary (n=11); cutaneous (n=3); cardiac (n=2); ocular (n=1); systemic (n=1) (with overlapping features in certain patients). Sarcoidosis was treated as follows: glucocorticoids (n=8); azathioprine (n=1); cardiac re-synchronisation therapy (n=1); heart transplant (n=1). All patients were reported to have survived, with one requiring intensive care admission.

CONCLUSIONS

Our result suggests there is a potential link between COVID-19 and new-onset sarcoidosis. The potential mechanism for this is through cytokine mediated immune modulation in COVID-19 infection. Obtaining a tissue sample remains key in confirming the diagnosis of sarcoidosis and this may be delayed during active COVID-19 infection.

Sarcoidosis following COVID infection: A case series

Here we describe three cases of sarcoidosis which were diagnosed following COVID infection. Treating clinicians should consider post-COVID-19 sarcoidosis in their differential, as it represents a potentially treatable cause of persistent symptomatology.

Sarcoidosis developing after COVID-19: A case report

COVID-19 has been implicated in the development of a range of autoimmune diseases and medical consequences. Sarcoidosis is an inflammatory disease with sustained granulomatous inflammation. The possible main pathogenesis of sarcoidosis is a dysregulation between immune response and certain environmental antigens. We present a case of sarcoidosis as an interesting sequela of COVID-19. The patient was hospitalized due to SARS-CoV-2 without complication. Ten weeks after the illness, his chest computed tomography (CT) showed bilateral hilar, paratracheal and subcarinal lymph node enlargement. Endobronchial ultrasound with transbronchial needle aspiration (EBUS-TBNA) was performed; pathologic findings were that of well-formed non-necrotizing granulomas. Complete eye examination reported panuveitis and papillitis in both eyes. On the basis of these findings, sarcoidosis was diagnosed. Therefore, sarcoidosis developing after COVID-19 was suggested as a possible link between the viral infection and dysregulation of the inflammation process. However, further studies are needed to confirm this association.

Cardiac sarcoidosis and giant cell myocarditis after COVID-19 infection

Patients infected with SARS-CoV-2 have varying manifestations of cardiac involvement. We report four patients presenting with symptomatic cardiac sarcoidosis (CS) or giant cell myocarditis (GCM) 1-8 months after mild COVID-19. All patients received immunosuppressive therapy and improved gradually within the following months. The possible temporal association between the CS/GCM and COVID-19 infection might suggest that COVID-19 could be a trigger for granulomatous myocarditis.

COVID-19 mRNA Vaccine-Associated Uveitis Leading to Diagnosis of Sarcoidosis: Case Report and Review of Literature

A 34-year-old Japanese person with male gender identity who had been taking intramuscular injection of methyltestosterone depot for 11 years after bilateral mastectomy noticed blurred vision 5 days after the second vaccination for COVID-19 (Tozinameran; Pfizer-BioNTech) in the interval of 3 weeks following the first vaccination. The patient was diagnosed as granulomatous iritis with mutton-fat keratic precipitates and small iris nodules at the pupillary margin in the right eye and began to have 0.1% betamethasone eye drops with good response. The patient, however, continued to have fever and malaise and showed a high level of serum soluble interleukin-2 receptor (sIL-2R) even 4 weeks after the second vaccination. Computed tomographic scan disclosed mediastinal and bilateral hilar small lymphadenopathy together with limited granular lesion in the right lung. Gallium-67 scintigraphy demonstrated high uptake not only in mediastinal and hilar lymph nodes but also in bilateral parotid glands. Right parotid gland biopsy revealed noncaseating granulomas and proved pathological diagnosis of sarcoidosis. The systemic symptoms were relieved by oral prednisolone 20 mg daily. Even though the causal relationship remains undetermined, this case is unique at the point that vaccine-associated uveitis led to the detection of pulmonary lesions and lymphadenopathy, resulting in clinical and pathological diagnosis of sarcoidosis. In literature review, 3 patients showed sarcoidosis-like diseases after COVID-19 vaccination: 2 patients were diagnosed clinically as Lofgren syndrome with acute onset of erythema nodosum and ankle swelling, with or without mediastinal and hilar lymphadenopathy, whereas 1 patient with mediastinal lymphadenopathy but no uveitis was diagnosed pathologically by biopsy as sarcoidosis.