A Novel Development of Sarcoidosis Following COVID-19 Vaccination and a Literature Review

Abstract

BNT162b2 (Pfizer/BioNTech) is a coronavirus disease 2019 (COVID-19) vaccine containing nucleoside-modified messenger RNA encoding the severe acute respiratory syndrome coronavirus 2 spike glycoprotein. Recently, ocular complications of mRNA vaccines have been reported increasingly frequently. However, immunological adverse events due to mRNA vaccines in real-world settings are not fully known. We herein report the novel development of sarcoidosis manifested as uveitis, bilateral hilar lymphadenopathy, angiotensin-converting enzyme elevation, and epithelioid and giant cell granuloma formation in the lung soon after the first BNT162b2 injection and review the current literature, including three reported cases of sarcoid-like reaction following COVID-19 vaccination.

Keywords: COVID-19; angiotensin-converting enzyme (ACE); mRNA vaccine; sarcoidosis; uveitis.

Figure 1.

Timeline and the ocular manifestation of the current case. A: timeline of the current case. B: right corner nodules are indicated by arrows. C: right vitreous turbidity was present. D: left perivenous inflammation is indicated by arrows. rt: right, lt: left, BHL: bilateral hilar lymphadenopathy

Figure 2.

Radiological and histopathologic findings of hilar and mediastinal lymphadenopathy. A: Chest X-ray (CXR) revealed marked bilateral hilar lymphadenopathy (BHL) on respiratory consultation. B: Normal CXR findings from the previous year. C: Contrast-enhanced chest computed tomography showed bilateral hilar and mediastinal lymphadenopathy. There were no remarkable findings in the lung parenchyma. D: Gallium (Ga)-67 scintigraphy showed an increased uptake in the ocular lesion (so-called panda sign) and bilateral hilar and mediastinal lymph nodes. E: Histopathological findings of a trans-bronchial lung biopsy (TBLB). A representative image of Hematoxylin and Eosin staining. A small non-caseating granuloma that consisted of tightly packed epithelioid cells (arrowheads), and a few admixed multinucleated giant cells (an arrow) and lymphocytes. Scale bar: 100 μm.