First reported case of erythrodermic sarcoidosis with systemic involvement during vaccination for Covid-19

Abstract

Post-vaccinal and parainfectious activation of the immunity with subsequent development of a certain immunological/skin-immunological disease isn’t rare in the clinical practice. This concept is mentioned in relation to molecular/antigenic mimicry. To this day, the pathogenesis of sarcoidosis and sarcoid-type reactions remains a mystery. Moreover, they can be a warning sign of changes in tissue homeostasis, whether it is infectious, non-infectious-immunological, tumor-related, etc. We present a rare form of erythrodermic sarcoidosis with massive systemic involvement (pericarditis, supraventricular tachycardia, hepatitis, iritis/iridocyclitis, pulmonary fibrosis/bihilar lymphadenopathy, and arthritis) developed after receiving the ChadOx1-S vaccine for Covid-19. Systemic immunosuppressive therapy with Methylprednisolone was introduced according to a scheme (in a reduction mode with an initial dose of 40 mg/day intravenously) in combination with: topical Pimecrolimus 1% cream twice a day. Rapid improvement of the symptoms was observed within the first two days of treatment. According to the references in the scientific literature, the presented patient turns out to be the first case of erythrodermic sarcoidosis (with systemic involvement), described as a side effect after vaccination and/or administration of a certain medicinal form.

A case of cutaneous sarcoidosis with pulmonary involvement after SARS-CoV-2 mRNA vaccination

“…To our knowledge, this is the first case of typical cutaneous sarcoidosis after COVID-19 vaccination that was confirmed using biopsy 2 , 3 , 6 , 7 , 8 , 9 ( Table I ). In a previous report of Löfgren’s syndrome, skin lesions presented as erythema nodosum rather than cutaneous sarcoidosis, although a biopsy was not performed.…”

“…Systemic glucocorticoids and disease-modifying antirheumatic drugs are recommended in cases of systemic involvement. 9 According to previous reports, improvement in sarcoidosis following COVID-19 vaccination has been achieved in most patients after treatment. 6 , 7 …”