ABSTRACT
TOPIC: Chest Infections TYPE: Fellow Case Reports INTRODUCTION: The recent SARS-CoV-2 pandemic has immensely affected individuals worldwide leading to a serious global emergency. It has the capability to end in post-infection complications and critical outcomes due to significant pro-inflammatory conditions. The role of SARS-CoV-2 in patients with immune disorders, such as sarcoidosis, and the specific interaction between these two diseases remains unclear. Here we present a case of a 65-year-old female with sarcoidosis who got infected with SARS-CoV-2 complicated by pulmonary embolism (PE) and COVID associated pulmonary aspergillosis (CAPA) CASE PRESENTATION: A 60-year-old African American female with a PMH of Sarcoidosis, Chronic thromboembolic pulmonary hypertension (CTEPH) on Riociguat, Macitentan, and Warfarin presented with cough, SOB, and fever for 1-week duration. Upon arrival to the ED, vital signs were significant for tachypnea and hypoxemia. COVID-19 PCR was positive. Initial chest CT revealed bilateral ground-glass opacities (GGOs) with multilobar chronic airspace disease. She was treated with Remdesivir and dexamethasone. During the hospital course, warfarin was held due to supratherapeutic INR. However, before discharge her respiratory parameters decompensated and she required HFNC to maintain her saturation. CT pulmonary angiogram revealed PE in the right distal segmental branch with significant bilateral patchy infiltrates more severe in the distribution of lower lobe suggestive of multilobar pneumonia with bilateral GGOs with crazy paving. Beta galactomannan came back positive and Voriconazole was started empirically with significant improvement in respiratory symptoms. Later fungal culture from sputum confirmed aspergillosis. DISCUSSION: SARS-CoV-2 activates the immune system which results in a release of inflammatory cytokines and leads to cytokine storms. But it remains unknown how the interaction differs in patients with an altered immune system, especially in cases of impairment of the T-cell immunity and granuloma formation, such as sarcoidosis. Some authors suggested that constitutional defects of the regulation of macroautophagy in sarcoidosis could lead to a more severe outcome from the novel SARS-CoV-2 infection. literature review showed that alveolar damage, dysfunctional mucociliary clearance, and altered immune system further facilitates fungal invasion. We, therefore, hypothesize that SARS-CoV-2 in a patient with underlying sarcoidosis may lead to increased risk for pulmonary aspergillosis. CONCLUSIONS: The role of infection from the novel coronavirus in patients having sarcoidosis is still largely unknown however clinicians should be aware that it has the risk of serious complications and clinical deterioration including further destruction of lung architecture, hypervascular response, hypercoagulability, and superinfection like CAPA. REFERENCE #1: https://www.lung.org/lung-health-diseases/lung-disease-lookup/sarcoidosis/learn-about-sarcoidosis REFERENCE #2: https://www.hopkinsmedicine.org/health/conditions-and-diseases/pulmonary-sarcoidosis REFERENCE #3: https://www.nature.com/articles/s41379-020-00661-1#citeas DISCLOSURES: No relevant relationships by Danilo Enriquez, source=Web Response No relevant relationships by SM Hossain, source=Web Response No relevant relationships by Tahmina Jahir, source=Web Response No relevant relationships by Ruby Risal, source=Web Response No relevant relationships by Marie Frances Schmidt, source=Web Response No relevant relationships by Binav Shrestha, source=Web Response No relevant relationships by Sabbena Uppal, source=Web Response