RARE EXPRESSION OF SYSTEMIC SARCOIDOSIS AFTER A NOVEL RNA VACCINE

Autor: Juan G. Feliciano-Figueroa, Jose Colon-Marquez, Stephanie Ortiz-Troche, Ian Da Silva Lugo, Jerome Ramirez-Marquez, Gabriela Negron-Ocasio, Juan Santiago, Luis Velazquez, Kimberly Padilla Rodriguez
Rok vydání: 2021
Předmět:
Zdroj: Chest. 160:A1233-A1234
ISSN: 0012-3692
DOI: 10.1016/j.chest.2021.07.1134
Popis: TOPIC: Diffuse Lung Disease TYPE: Medical Student/Resident Case Reports 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. REFERENCE #1: Grunewald, J., Grutters, J. C., Arkema, E. V., Saketkoo, L. A., Moller, D. R., & Muller-Quernheim, J. (2019). Sarcoidosis. Nature Reviews Disease Primers, 5(1).doi:10.1038/s41572-019-0096-x REFERENCE #2: Greco FG, Spagnolo P, Muri M, et al. The value of chest radiograph and computed tomography in pulmonary sarcoidosis. Sarcoidosis, Vasculitis, and Diffuse Lung Diseases: Official Journal of WASOG. 2014 Jul;31(2):108-116. REFERENCE #3: Saygin, D., Karunamurthy, A., English, J., & Aggarwal, R. (2018). Tattoo reaction as a presenting manifestation of systemic sarcoidosis. Rheumatology. doi:10.1093/rheumatology/key316 DISCLOSURES: No relevant relationships by Jose Colon-Marquez, source=Admin input No relevant relationships by Ian Da Silva Lugo, source=Web Response No relevant relationships by Juan Feliciano-FIgueroa, source=Web Response No relevant relationships by Gabriela Negron-Ocasio, source=Web Response No relevant relationships by Stephanie Ortiz-Troche, source=Web Response No relevant relationships by Kimberly Padilla Rodriguez, source=Admin input No relevant relationships by Jerome Ramirez-Marquez, source=Web Response No relevant relationships by Juan Santiago, source=Web Response No relevant relationships by Luis Velazquez, source=Web Response
Databáze: OpenAIRE
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