Rare Expression of Systemic Sarcoidosis After a Novel Rna Vaccine

Abstract

INTRODUCTION:Sarcoidosis is a multisystem disorder of unknown etiology. Some cases are attributed to genetic factors, an inflammatory response by specific antigens including self-antigen, and autoimmune involvement. Ninety percent of patients with sarcoidosis have lung involvement, and a vast portion is asymptomatic. Most common initial symptoms are dry cough and dyspnea, however, manifestation can be unspecific and broad. Ocular manifestations like uveitis are a classical presentation. Cutaneous manifestations have also been associated with sarcoidosis but incidence is around 1.9 per 100,000 with a female predominance. Diagnosis can be performed from clinical, and radiological findings yet one of the most essential criteria is histopathological findings of non-caseating granulomas on a tissue biopsy. Here is a rare presentation of a Hispanic male with sarcoidosis after exposure to an unusual antigen.CASE PRESENTATION: A 32-year-old man came to the emergency department with dyspnea, dry cough, and bilateral eye redness of one week of evolution and ten days after the second dose of the SARS-CoV-2 vaccine. Before these symptoms, the patient experienced multiple desquamating tattoos and bilateral eye redness after the first dose of the vaccine, which presumed that resolved with tobramycin and dexamethasone eye drops. Physical examination was notable for tattoo peeling with surrounding erythematous papules and tenderness to palpation. Eye examination revealed an intact visual acuity bilaterally with hyperemia and conjunctival injection. Ophthalmology made the diagnosis of non-granulomatous bilateral anterior uveitis. Routine laboratories were unremarkable including angiotensin-converting enzyme levels except for erythrocyte sedimentation rate on 32mm/Hr and arterial blood gas with a partial pressure of oxygen of 72 mmHg. Chest radiograph revealed innumerable bilateral centrilobular nodules. Chest Computerized tomography showed bilateral centrilobular diffuse pulmonary nodules with associated mediastinal paratracheal and mediastinal lymphadenopathy. Skin biopsy revealed a nodular infiltrate of histiocytes with black foreign body deposits with non-caseating sarcoid granulomas. Treatment consisted of prednisone and azathioprine resulting in an improvement of symptoms the following days. DISCUSSION:The side effects of this novel ribonucleic acid vaccine are not well described yet, but our case raises the suspicion if the vaccine arouses or unmask autoimmune diseases like the one previously described.CONCLUSIONS: More studies and data are required on side effects to assess other possible complications, response to the vaccine, and which patients are at risk of developing autoimmune or serious health conditions.

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.…”

Unmasking sarcoidosis following SARS‐CoV‐2 vaccination: A case report

“…There are abundant reports of lymphadenitis, erythema nodosum, and skin reactions following SARS‐CoV‐2 vaccination, but the simultaneous onset of peripheral and paratracheal lymphadenopathy, along with erythema nodosum, is highly suggestive of sarcoidosis. Although ACE elevation supported our diagnosis, definite diagnosis was made by tissue histopathological examination showing noncaseating granulomas 21–26 …”

“…Although ACE elevation supported our diagnosis, definite diagnosis was made by tissue histopathological examination showing noncaseating granulomas. 21 , 22 , 23 , 24 , 25 , 26 …”

“…Although ACE elevation supported our diagnosis, definite diagnosis was made by tissue histopathological examination showing noncaseating granulomas. [21][22][23][24][25][26] Sarcoidosis-related skin lesions do not usually need treatment if are not cosmetically serious or accompanied by other organ involvement. In isolated cutaneous sarcoidosis, local corticosteroid, either topical or intralesional, usually suffice.…”

Does SARS-CoV-2vaccination induce acquired autoimmune discords and inflammatory manifestations?

“…The main symptoms of these cases were fever, fatigue, dyspnea, and dry cough. 20 , 21 Previously, it has been reported a case of sarcoidosis exacerbation presenting after SARS-CoV-2 vaccination. 22 …”