MULTISYSTEM SARCOIDOSIS ASSOCIATED WITH THE COVID-19 MRNA VACCINE

ABSTRACT

SESSION TITLE Unusual Presentations of Sarcoidosis SESSION TYPE Rapid Fire Case Reports PRESENTED ON 10/18/2022 0135 pm - 0235 pm INTRODUCTION: COVID-19 infection has brought high morbidity and strain on hospitals. Multiple vaccines have been developed against COVID and are now widely available. These vaccines have been linked to various side effects listed by the Centers for Disease Control and prevention (CDC) website- https//www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/adverse-events.html. We present a case of multisystem sarcoidosis after receiving an mRNA COVID-19 vaccine. CASE PRESENTATION Our patient is a 42-year-old African American woman who reported low grade fever after her first dose of the BNT162b2 mRNA COVID-19 vaccine (Pfizer). After her second dose, the fever continued, and fatigue and lethargy were noted. She denied any respiratory symptoms and other review of systems were negative. She was referred for autoimmune workup by her PCP. Then, she received her booster dose (~6 months after the second dose) and 2 weeks later, she noticed a right posterior calf mass that was firm and non-tender on exam. Rest of the exam was unremarkable. Orthopedic surgery was involved, and an excision-biopsy was done. Pathology demonstrated non-necrotizing granulomatous inflammation (Figure 1A). Her blood counts and metabolic panel were normal. Other labs showed elevated C-reactive protein of 19 mg/L (normal < 5 mg/L), angiotensin-converting enzyme level of 93 U/L (normal is 9-67 ) and Vitamin D level of 8.4 ng/mL (normal is 20-50 ng/mL). She was referred to pulmonary clinic for further evaluation. Pulmonary function test showed mild restrictive physiology. CT chest revealed enlarged mediastinal and hilar lymph nodes (Figure 2) and lung parenchymal involvement (Figure 3). EBUS-guided TBNA was performed and showed granulomatous inflammation. (Figure 1B). DISCUSSION: We present a case of multisystem sarcoidosis with mediastinal and soft tissue compromise in a temporal association with Pfizer mRNA COVID-19 vaccine. This is an uncommon adverse reaction and has not been reported by the CDC. In our case, there is a strong temporal relationship between the vaccination schedule and onset of symptoms, starting with fever and tiredness as common side effects that progressed to mass-like lesion in leg and mediastinal adenopathy. Cutaneous sarcoidosis might occur with COVID-19 vaccines (#1), however only 3 cases of multisystem sarcoidosis have been reported so far. Two cases developed Lofgren syndrome after the COVID-19 vaccination (#2) and one case with uveitis and parotid compromise (#3). To the best of our knowledge, this is the first case reporting sarcoidosis with soft tissue involvement in association with Pfizer mRNA COVID-19 vaccine. CONCLUSIONS: Our patient met criteria for multisystem sarcoidosis and there is a strong temporal relationship between the onset of symptoms/disease and COVID-19 vaccine. Immunological adverse events related to vaccines are uncommon. Our case elucidates to consider the diagnosis in right clinical context. Reference #1 Niebel D, Novak N, Wilhelmi JZ, Wilsmann-Theis D, Bieber T et al. Cutaneous adverse reactions to COVID-19 vaccines Insights from an immune-dermatological perspective. Vaccines 2021,9,944. Reference #2 Rademacher J, Tampe B and Korsten P. First Report of Two Cases of Löfgren's Syndrome after SARS-CoV-2 Vaccination-Coincidence or Causality? Vaccines 2021, 9, 1313. https//doi.org/10.3390/ vaccines9111313 Reference #3 Matsuo T, Honda H, Tanaka T, Uraguchi K, Kawahara M et al. COVID-19 mRNA vaccine-associated uveitis leading to diagnosis of Sarcoidosis case report and review of literature. J Investig Med High Impact Case Rep. 2022 Jan-Dec;10 23247096221086450. DISCLOSURES No relevant relationships by Chien Chen No relevant relationships by Eleonora Fiorletta Quiroga No relevant relationships by Manish Joshi No relevant relationships by Angel Mitma No relevant relationships by PRACHI SALUJA