Sarcoidosis, a rare inflammatory disease, is emerging as a potential complication in some individuals who have recovered from COVID-19. Medical experts are sounding the alarm about this enigmatic condition, which involves the formation of granulomas, or clusters of inflamed tissue, in various organs of the body. Although the exact cause of sarcoidosis remains unknown, it is believed to be triggered by an immune reaction, potentially stemming from infections or genetic predisposition.
While the focus of COVID-19 research has largely been on respiratory issues, this case series sheds light on the connection between SARS-CoV-2 and sarcoidosis. British physicians from St Mary’s Hospital, Imperial College Healthcare NHS Trust, Imperial College London, and Cambridge University Hospitals NHS Trust have presented three cases in which sarcoidosis was diagnosed following COVID-19 infections. These cases serve as a reminder for medical professionals to consider sarcoidosis as a possible cause of persistent and debilitating symptoms post-COVID-19.
The first case involves a 64-year-old male who experienced symptoms such as cough, breathlessness, fever, myalgia, and fatigue in March 2020 after a COVID-19 infection. Despite not requiring hospitalization, the patient continued to experience breathlessness and fatigue, leading to a visit to the post-COVID clinic. Chest imaging revealed unusual shadowing and a subsequent high-resolution CT scan showed ground glass opacification and consolidation in the lungs. The patient’s lung function tests also indicated abnormalities. A lung biopsy confirmed the presence of sarcoidosis, and treatment with prednisolone led to significant improvement in symptoms.
The second case involves a 53-year-old female who tested positive for SARS-CoV-2 in December 2020. After experiencing worsening symptoms, she was hospitalized and diagnosed with severe COVID-19 pneumonitis. Post-discharge, the patient continued to experience breathlessness, cough, and persistent imaging abnormalities. Further testing revealed granulomatous inflammation consistent with sarcoidosis. Despite reduced lung function, no immunosuppressive treatment was initiated at the time.
In the third case, a 43-year-old male who had been fully vaccinated experienced asymptomatic COVID-19 in December 2021. Months later, he developed various respiratory symptoms and a rash on his shins. Imaging revealed lymphadenopathy and micronodularity, indicative of stage 2 sarcoidosis. Lymph node biopsy confirmed granulomatous inflammation, suggesting a potential link between COVID-19 and sarcoidosis.
The emergence of sarcoidosis following COVID-19 infections may be more common than previously thought. Some cases, referred to as sarcoid-like reactions, have been reported where granulomatous panniculitis developed in the post-infection period. However, further research is needed to understand the underlying mechanisms of this connection.
Possible explanations for the COVID-19-sarcoidosis link include the downregulation of ACE2 by SARS-CoV-2, leading to an inflammatory response. Sarcoidosis is associated with elevated ACE levels, although the cases presented here did not show abnormal ACE levels. Additionally, similarities between the immune features of sarcoidosis and severe COVID-19 suggest a shared pathophysiology involving inflammation and cytokine dysregulation. The role of defective autophagy, negatively regulated by angiotensin II increased in coronavirus infections, is also being investigated.
As the world continues to grapple with the long-term consequences of the COVID-19 pandemic, it is crucial for medical professionals to consider sarcoidosis as a potential post-infection complication. The cases presented in this report highlight the importance of vigilance and further research in understanding the relationship between COVID-19 and sarcoidosis. The underlying mechanisms and risk factors need to be explored to facilitate the development of effective management strategies for individuals experiencing persistent symptoms after recovering from COVID-19.
Please note that this article is for informational purposes only and should not be taken as medical advice.
