Massive macroglossia, a rare side effect of COVID-19: clinical, histologic, and genomic findings in COVID-19-positive versus COVID-19-negative patients

Abstract

Purpose The primary purpose of this study is to identify if there is an underlying genetic predisposition for COVID-related macroglossia and if this susceptibility is higher among individuals of African heritage. Secondary objectives include determining if genetic testing of COVID-infected patients who are intubated and prone could identify patients with higher susceptibility to the development of macroglossia. Methods A retrospective chart review was completed for each patient, and prospectively, genetic and histopathologic analyses were completed. Whole-exome sequencing was completed on two patients; immunohistochemistry was completed on the COVID-positive tissue samples. Results Histopathology of the COVID-positive patient revealed significant peri-lymphocytic infiltrate, which was absent in the COVID-negative patient. Immunohistochemistry confirmed the presence of immune cells. Results from the whole-exome sequencing were inconclusive. Conclusion The findings of this study are consistent with others that have observed a lymphocytic infiltrate in the organs of patients infected with SARS-CoV-2. On histology, IHC highlighted a CD45 + predominance, indicating that a robust immune response is present in the tissues. The pathobiology of this phenomenon and its role in the development and/or persistence of massive macroglossia requires further study.

Coronavirus disease-19 infection and angioedema in African Americans: A case series

“…This subject had late improvement of lip swelling, and tongue swelling was refractory to medical therapy, which prompted the performance of tracheostomy as a bridge for extubation. In this case, we believe that the refractoriness of tongue swelling was likely related to a strong immune response against COVID-19 infection, as similarly reported in the literature, where massive tongue lymphocytic infiltrates were described in a patient with severe COVID-19 and macroglossia [ 6 ].…”

Two Cases of COVID-Related Osteonecrosis of the Jaws: A New and Worrying Entity Is Emerging

“…But was not long after we left what was considered the zone of greatest risk that the side effects of COVID hit. Multiple cases of anosmia causing depression and suicidal thoughts, memory deficits causing a range of daily problems, macroglossia and many others that we have to live with, at least for a while, while the answers do not come 4 . These consequences include musculoskeletal changes.…”