The Onset of Sarcoidosis After COVID-19 Vaccination Revealed by the 18F-FDG PET

Abstract

Sarcoidosis is a heterogeneous multisystem disease characterized by noncaseating granulomas. We presented 18F-FDG PET/CT findings of sarcoidosis in a previously healthy 43-year-old man who presented intermittent cough after the third dose of COVID-19 vaccination. 18F-FDG PET/CT showed high uptake of one solitary nodule in the right middle lobe, mediastinal lymph nodes, bilateral hila, and multiple nodules under the right pleura, mimicking the malignancy. Nevertheless, the biopsy confirmed distinct noncaseating granulomas. This case emphasizes the onset of sarcoidosis revealed by 18F-FDG PET/CT after COVID-19 vaccination.

Drug-induced sarcoidosis-like reaction three months after BNT162b2 mRNA COVID-19 vaccination: A case report and review of literature

“…Taken together with above reports[ 29 - 31 ], the present case suggests that the sarcoidosis-like reaction might be induced by the mRNA vaccination.…”

Widespread Reactive Lymphatic and Splenic FDG Avidity After mRNA COVID Vaccination

“…Given the resolution of abnormalities in the absence of change in treatment, the prior findings were favored to be reactive or inflammatory rather than metastatic, likely related to the COVID mRNA vaccination given the temporal proximity. Although axillary lymphatic FDG avidity unilateral to the injection site is a common finding after mRNA vaccination, 1 widespread lymphatic involvement is a much rarer finding, although cases of onset of systemic inflammatory response syndrome 2 and sarcoidosis 3 have been reported, as well as inguinal and retroperitoneal involvement ipsilateral to a thigh injection 4 and splenic uptake 5 . mRNA vaccine-related uptake typically occurs within the first 6–12 days after injection, 6 and thus delaying PET/CT until 2 weeks after vaccination is preferable, particularly with malignancies that are most vulnerable to these confounding findings such as lymphoma, although urgent PET/CT should be performed regardless 7 .…”

Bivalent mRNA COVID-19 Vaccine–Related Pericarditis on 18F-FDG PET/CT

“…Cardiac MRI has been considered the best noninvasive diagnostic tool for diagnosis of myocarditis 2. There have been a variety of postvaccination nuclear medicine imaging findings, not confined to FDG PET, in the literature during this short period of COVID-19 pandemic [3][4][5][6][7][8][9]. The carbohydrate-free, high-fat diet is useful to minimize physiological cardiac uptake of FDG, which helps to correctly evaluate pericardial or myocardial inflammation 10.…”

“…2 There have been a variety of postvaccination nuclear medicine imaging findings, not confined to FDG PET, in the literature during this short period of COVID-19 pandemic. [3][4][5][6][7][8][9] The carbohydrate-free, high-fat diet is useful to minimize physiological cardiac uptake of FDG, which helps to correctly evaluate pericardial or myocardial inflammation. 10 Our current case provides a unique finding of simultaneous demonstration of vaccination-related axillary lymphadenopathy and pericarditis after a second booster dose of the bivalent mRNA COVID-19 vaccine.…”