ABSTRACT
SESSION TITLE: Issues After COVID-19 Vaccination Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Sarcoidosis and sarcoid-like reactions tend to be diagnoses of exclusion when evaluating patients with malignancy, and have a number of inciting causes. This is a unique case of a patient diagnosed with non-necrotizing granulomatous inflammation on biopsy of mediastinal lymph nodes and skin lesions after receiving SARS-CoV-2 vaccine, while also being on Temozolamide (TMZ). Biopsy-proven sarcoid has rarely been reported in the literature following SARS-CoV-2 vaccine or TMZ. CASE PRESENTATION: 66-year-old female with a history of prolactinoma complicated by recurrence and progression of disease despite surgery, radiation, and medical therapy, who started her first cycle of TMZ and received her first SARS-CoV-2 vaccine 9 days later. About 2 weeks later, she noted numerous painless "bumps” on her bilateral upper and lower extremities with erythema, without fevers, joint pains, or other symptoms. She underwent a positron emission tomography (PET) scan which demonstrated multiple hypermetabolic subcutaneous lesions, along with intensely hypermetabolic bilateral hilar lymphadenopathy. She underwent punch biopsy notable for sparse inflammation. She underwent her second SARS-CoV-2 vaccine and second cycle of TMZ. After 1 week, she noticed increased induration and erythema over her lesions, and held her TMZ. She underwent incisional biopsy of her thigh which demonstrated granulomatous panniculitis. She also underwent bronchoscopy with endobronchial ultrasound (EBUS) and transbronchial needle aspiration (TBNA) of her paratracheal and subcarinal lymph nodes, which demonstrated non-necrotizing granulomatous inflammation. Labs were only significant for ACE level of 60u/L (normal<40u/L). With a relative paucity of symptoms and no other obvious vital organ involvement, she was not treated, continued her TMZ without flares, and her symptoms self-resolved after opting out of the third SARS-CoV-2 vaccine. DISCUSSION: Sarcoid-like inflammatory reactions have rarely been reported in the literature following SARS-CoV-2 vaccine or TMZ. One case of panniculitis secondary to TMZ administration was reported that improved after discontinuation of TMZ [1]. Our patient continued TMZ therapy without further symptoms, which makes TMZ less likely as her inciting cause. Three cases of sarcoid-like reactions secondary to SARS-CoV-2 vaccine have been reported [2, 3] but two of these cases were diagnosed clinically as Löfgren syndrome without biopsy [3], making this case the second reported case of biopsy-proven de novo sarcoid reaction in the setting of SARS-CoV-2 vaccine. CONCLUSIONS: Sarcoid-like inflammatory reactions following SARS-CoV-2 vaccine have not been well-reported in the literature. This case, among the other limited cases reported, underscores the need to consider sarcoid on the differential of vaccine-related side effects, especially in those with bilateral hilar lymphadenopathy and cutaneous lesions. Reference #1: Virmani P., Chung E., Marchetti M. A. (2015). Cutaneous adverse drug reaction associated with oral temozolomide presenting as dermal and subcutaneous plaques and nodules. Jaad. Case. Rep. 1, 286–288. 10.1016/j.jdcr.2015.06.012 Reference #2: Bauckneht, M., Aloè, T., Tagliabue, E. et al. Beyond Covid-19 vaccination-associated pitfalls on [18F]Fluorodeoxyglucose (FDG) PET: a case of a concomitant sarcoidosis. Eur J Nucl Med Mol Imaging 48, 2661–2662 (2021). https://doi.org/10.1007/s00259-021-05360-w Reference #3: Rademacher JG, Tampe B, Korsten P. First Report of Two Cases of Löfgren's Syndrome after SARS-CoV-2 Vaccination-Coincidence or Causality? Vaccines (Basel). 2021 Nov 11;9(11):1313. doi: 10.3390/vaccines9111313. PMID: 34835244;PMCID: PMC8619392 DISCLOSURES: no disclosure on file for Alexander Geyer;No relevant relationships by Mustafa Jafri