Sarcoidosis in a young adult: A rare sequelae of COVID-19 infection

Abstract

Key clinical message: This case illustrates sarcoidosis as a potential complication of COVID-19, highlighting the need for a comprehensive diagnostic approach, including histopathology and prolonged monitoring, to distinguish it from post-COVID fibrosis. Further research is crucial to elucidate these associations and understand their underlying mechanisms.

Abstract: Severe Acute Respiratory Syndrome Coronavirus- 2 (SARS-CoV-2), a positive-sense single-stranded RNA virus, causes COVID-19 and has been linked to autoimmune disorders. Sarcoidosis is a multi-system disease that is frequently triggered by infections. It is characterized by non-necrotizing granulomas in multiple organs. We present a case of sarcoidosis as rare sequelae of COVID-19. A 26-year-old man presented with mild COVID-19 symptoms, followed by prolonged fever and cough despite initial therapy, prompting a provisional diagnosis of post-COVID fibrosis. A subsequent assessment at a tertiary hospital revealed dyspnea, weight loss, and abnormal chest imaging, all of which were consistent with pulmonary sarcoidosis with pulmonary tuberculosis as a differential diagnosis. A biopsy taken during bronchoscopy confirmed pulmonary sarcoidosis and treatment with inhalation steroids resulted in symptom relief, which was followed by remission with oral steroid therapy. Sarcoidosis is a systemic disease of unknown etiology, characterized by non-necrotizing granulomas in multiple organs. It may be triggered by infections and involves an abnormal immune response. COVID-19 can potentially initiate sarcoidosis, with both sharing common immune mechanisms. Diagnosis involves imaging and biopsy, and treatment typically includes glucocorticoids and regular monitoring. This case report emphasizes the potential link between COVID-19 and autoimmune conditions like sarcoidosis, highlighting the need for a comprehensive diagnostic approach and long-term observation to distinguish between sarcoidosis and post-COVID fibrosis.

Keywords: SARS‐COV‐2; autoimmune disease; case report; post‐COVID fibrosis; sarcoidosis.

FIGURE 1

Chest x‐ray posterior–anterior view showing bilateral interstitial infiltrates.

FIGURE 2

Transverse section of Multi‐Detector Computed Tomography (MDCT) of the chest revealing discrete and confluent nodular opacities in the bilateral parahilar region involving peribronchovascular and subpleural location along with ground glass opacities in right upper and middle lobes.

FIGURE 3

Transverse section of contrast‐enhanced Computed Tomography (CT) of the chest revealing mild enhancement at the region of the nodule and consolidation.

FIGURE 4

Longitudinal section of Computed Tomography (CT) of the chest revealing discrete opacities in the bilateral perihilar region suggestive of hilar lymphadenopathy.

FIGURE 5

Histology showing granuloma with epithelioid histiocytes accompanied by peripheral rim of lymphocytes.