Sarcoidosis detected after COVID‑19 with T‑SPOT.TB positive: A case report

Wang,Qian; Geng,Jian; Liu,Xiaobei; Chen,Cheng; Chu,Xiaoyuan

doi:10.3892/etm.2023.12355

Sarcoidosis detected after COVID‑19 with T‑SPOT.TB positive: A case report

Authors:
- Qian Wang
- Jian Geng
- Xiaobei Liu
- Cheng Chen
- Xiaoyuan Chu
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Affiliations: Department of Medical Oncology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, Jiangsu 210000, P.R. China, Department of Medical Oncology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu 21000, P.R. China, Department of Medical Oncology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu 21000, P.R. China
Published online on: December 18, 2023 https://doi.org/10.3892/etm.2023.12355
Article Number: 67
Copyright: © Wang et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Sarcoidosis is an idiopathic multisystem disorder with unknown etiology. Due to clinical similarities among sarcoidosis, tuberculosis (TB) infection and malignant diseases (such as lymphoma, lung carcinoma and pituitary tumor), the diagnosis of sarcoidosis is challenging. The present report describes a case of sarcoidosis in a 48‑year‑old male with complaint of chest pain 1 month after Coronavirus disease 2019. The patient underwent whole‑body ¹⁸F‑fluorodeoxyglucose (¹⁸F‑FDG) PET‑CT imaging, which revealed multiple lymphadenopathies throughout the body without lung parenchyma involvement. Biochemical examinations such as T‑SPOT.TB test and pathological examination of right supraclavicular lymph node revealed positive T‑SPOT.TB but negative Ziehl‑Neelsen staining. However, non‑caseating epithelioid granulomas were observed in the mediastinal biopsy, indicating the diagnosis of sarcoidosis. The patient was clinically stable, and the symptom of chest pain was gradually relieved without any specific treatment. Outpatient follow‑up continued every 3 months. The present case suggested a possible link between coronavirus infection and sarcoidosis, which suggests the advantages of ¹⁸F‑FDG PET‑CT for the detection of sarcoidosis. However, T‑SPOT.TB is insufficient for differentiating between sarcoidosis and TB.

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1	Drent M, Crouser ED and Grunewald J: Challenges of sarcoidosis and its management. N Engl J Med. 385:1018–1032. 2021.PubMed/NCBI View Article : Google Scholar
2	Shahgaldi S, Abbasi A and Rahmani-Kukia N: A rapid qualitative review of sarcoidosis: Clinical manifestations, immunopathogenesis, diagnosis and treatment. Mini Rev Med Chem. 22:1619–1630. 2022.PubMed/NCBI View Article : Google Scholar
3	Dubaniewicz A: Mycobacterial heat shock proteins in sarcoidosis and tuberculosis. Int J Mol Sci. 24(5084)2023.PubMed/NCBI View Article : Google Scholar
4	Belperio JA, Fishbein MC, Abtin F, Channick J, Balasubramanian SA and Lynch Iii JP: Pulmonary sarcoidosis: A comprehensive review: Past to present. J Autoimmun: Oct 19, 2023 (Epub ahead of print).
5	Sève P, Pacheco Y, Durupt F, Jamilloux Y, Gerfaud-Valentin M, Isaac S, Boussel L, Calender A, Androdias G, Valeyre D and El Jammal T: Sarcoidosis: A clinical overview from symptoms to diagnosis. Cells. 10(766)2021.PubMed/NCBI View Article : Google Scholar
6	Bonham CA, Strek ME and Patterson KC: From granuloma to fibrosis: Sarcoidosis associated pulmonary fibrosis. Curr Opin Pulm Med. 22:484–491. 2016.PubMed/NCBI View Article : Google Scholar
7	Yazdanpanah N and Rezaei N: Autoimmune complications of COVID-19. J Med Virol. 94:54–62. 2022.PubMed/NCBI View Article : Google Scholar
8	Liu Y, Sawalha AH and Lu Q: COVID-19 and autoimmune diseases. Curr Opin Rheumatol. 33:155–162. 2021.PubMed/NCBI View Article : Google Scholar
9	Tana C, Cinetto F, Mantini C, Bernardinello N, Tana M, Ricci F, Ticinesi A, Meschi T, Scarpa R, Cipollone F, et al: Sarcoidosis and COVID-19: At the cross-road between immunopathology and clinical manifestation. Biomedicines. 10(2525)2022.PubMed/NCBI View Article : Google Scholar
10	Tana C, Donatiello I, Caputo A, Tana M, Naccarelli T, Mantini C, Ricci F, Ticinesi A, Meschi T, Cipollone F and Giamberardino MA: Clinical features, histopathology and differential diagnosis of sarcoidosis. Cells. 11(59)2021.PubMed/NCBI View Article : Google Scholar
11	Gupta D, Agarwal R, Aggarwal AN and Jindal SK: Sarcoidosis and tuberculosis: The same disease with different manifestations or similar manifestations of different disorders. Curr Opin Pulm Med. 18:506–516. 2012.PubMed/NCBI View Article : Google Scholar
12	Agrawal R, Kee AR, Ang L, Tun Hang Y, Gupta V, Kon OM, Mitchell D, Zierhut M and Pavesio C: Tuberculosis or sarcoidosis: Opposite ends of the same disease spectrum? Tuberculosis (Edinb). 98:21–26. 2016.PubMed/NCBI View Article : Google Scholar
13	Cho HS, Kim SJ and Yoo JY: Sarcoidosis during treatment of pulmonary tuberculosis: A rare case report and review of the literature. J Int Med Res. 49(3000605211001632)2021.PubMed/NCBI View Article : Google Scholar
14	Kaur H, Singh D and Pandhi N: Co-existence of pulmonary tuberculosis with sarcoidosis. Int J Mycobacteriol. 10:341–343. 2021.PubMed/NCBI View Article : Google Scholar
15	Yang M, Cao S, Liu Y, Zhang Z, Zheng R, Li Y, Zhou J, Zong C, Cao D and Qin X: Performance verification of five commercial RT-qPCR diagnostic kits for SARS-CoV-2. Clin Chim Acta. 525:46–53. 2022.PubMed/NCBI View Article : Google Scholar
16	Timmermans WM, van Laar JA, van Hagen PM and van Zelm MC: Immunopathogenesis of granulomas in chronic autoinflammatory diseases. Clin Transl Immunology. 5(e118)2016.PubMed/NCBI View Article : Google Scholar
17	Tana C, Mantini C, Cipollone F and Giamberardino MA: Chest imaging of patients with sarcoidosis and SARS-CoV-2 Infection. Current evidence and clinical perspectives. Diagnostics (Basel). 11(183)2021.PubMed/NCBI View Article : Google Scholar
18	Behbahani S, Baltz JO, Droms R, Deng AC, Amano SU, Levin NA, O'Brien MC and Wiss K: Sarcoid-like reaction in a patient recovering from coronavirus disease 19 pneumonia. JAAD Case Rep. 6:915–917. 2020.PubMed/NCBI View Article : Google Scholar
19	Polat Ekinci A, Büyükbabani N, Meşe S, Pehlivan G, Okumuş NG, Ağaçfidan A and Özkaya E: COVID-19-triggered sarcoidal granulomas mimicking scar sarcoidosis. J Eur Acad Dermatol Venereol. 35:e477–e480. 2021.PubMed/NCBI View Article : Google Scholar
20	Sester M, Sotgiu G, Lange C, Giehl C, Girardi E, Migliori GB, Bossink A, Dheda K, Diel R, Dominguez J, et al: Interferon-γ release assays for the diagnosis of active tuberculosis: A systematic review and meta-analysis. Eur Respir J. 37:100–111. 2011.PubMed/NCBI View Article : Google Scholar
21	Zhao M, Tian C, Cong S, Di X and Wang K: From COVID-19 to Sarcoidosis: How similar are these two diseases? Front Immunol. 13(877303)2022.PubMed/NCBI View Article : Google Scholar
22	Mazzoni A, Maggi L, Capone M, Spinicci M, Salvati L, Colao MG, Vanni A, Kiros ST, Mencarini J, Zammarchi L, et al: Cell-mediated and humoral adaptive immune responses to SARS-CoV-2 are lower in asymptomatic than symptomatic COVID-19 patients. Eur J Immunol. 50:2013–2024. 2020.PubMed/NCBI View Article : Google Scholar
23	Jubel JM, Barbati ZR, Burger C, Wirtz DC and Schildberg FA: The Role of PD-1 in acute and chronic infection. Front Immunol. 11(487)2020.PubMed/NCBI View Article : Google Scholar
24	Kim KJ, Ryu SE, Lee HN, Oh SH and Chang CL: Evaluation of a new chemiluminescent immunoassay-based interferon-gamma release assay for detection of latent tuberculosis infection. Medicina (Kaunas). 59(1734)2023.PubMed/NCBI View Article : Google Scholar
25	Diel R, Loddenkemper R and Nienhaus A: Evidence-based comparison of commercial interferon-gamma release assays for detecting active TB: A metaanalysis. Chest. 137:952–968. 2010.PubMed/NCBI View Article : Google Scholar
26	Kempisty A, Białas-Chromiec B, Borkowska D and Kuś J: Interferon gamma release assays based on M. tuberculosis-specific antigens in sarcoidosis patients. Pneumonol Alergol Pol. 83:126–134. 2015.PubMed/NCBI View Article : Google Scholar
27	https://www.who.int/publications/i/item/9789240056084.
28	Chen X, Xu X, Chrysikos S, Zhao M and Zhou Y: Value of 18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in the differential diagnosis of sarcoidosis and lung cancer with lymph node metastasis: A retrospective study. Transl Lung Cancer Res. 11:1926–1935. 2022.PubMed/NCBI View Article : Google Scholar
29	Tetikkurt C, Yanardag H, Sayman BH, Bilir M, Tetikkurt S, Bilgic S, Kubat B and Bilgin S: Diagnostic utility of 68Ga-citrate and 18FDG PET/CT in sarcoidosis patients. Monaldi Arch Chest Dis. 90:2020.PubMed/NCBI View Article : Google Scholar
30	Kouijzer IJE, Mulders-Manders CM, Bleeker-Rovers CP and Oyen WJG: Fever of unknown origin: The Value of FDG-PET/CT. Semin Nucl Med. 48:100–107. 2018.PubMed/NCBI View Article : Google Scholar
31	Régis C, Benali K and Rouzet F: FDG PET/CT imaging of sarcoidosis. Semin Nucl Med. 53:258–272. 2023.PubMed/NCBI View Article : Google Scholar
32	Racil H, Znegui T, Maazoui S, Touil A, Habibech S, Henda N and Chaouch N: Can coronavirus disease 2019 induce sarcoidosis: A case report. Thorac Res Pract. 24:45–58. 2023.PubMed/NCBI View Article : Google Scholar