Lofgren syndrome in close temporal association with mild COVID-19 - Case report.
TL;DR: In this paper, a case of Lofgren syndrome developing in close temporal association with COVID-19 was reported, which is a rare autoimmune disease that represents an acute form of sarcoidosis.
About: This article is published in IDCases.The article was published on 2021-01-01 and is currently open access. It has received 5 citations till now. The article focuses on the topics: Sarcoidosis & Erythema nodosum.
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TL;DR: This case is unique at the point that vaccine-associated uveitis led to the detection of pulmonary lesions and lymphadenopathy, resulting in clinical and pathological diagnosis of sarcoidosis.
Abstract: A 34-year-old Japanese person with male gender identity who had been taking intramuscular injection of methyltestosterone depot for 11 years after bilateral mastectomy noticed blurred vision 5 days after the second vaccination for COVID-19 (Tozinameran; Pfizer-BioNTech) in the interval of 3 weeks following the first vaccination. The patient was diagnosed as granulomatous iritis with mutton-fat keratic precipitates and small iris nodules at the pupillary margin in the right eye and began to have 0.1% betamethasone eye drops with good response. The patient, however, continued to have fever and malaise and showed a high level of serum soluble interleukin-2 receptor (sIL-2R) even 4 weeks after the second vaccination. Computed tomographic scan disclosed mediastinal and bilateral hilar small lymphadenopathy together with limited granular lesion in the right lung. Gallium-67 scintigraphy demonstrated high uptake not only in mediastinal and hilar lymph nodes but also in bilateral parotid glands. Right parotid gland biopsy revealed noncaseating granulomas and proved pathological diagnosis of sarcoidosis. The systemic symptoms were relieved by oral prednisolone 20 mg daily. Even though the causal relationship remains undetermined, this case is unique at the point that vaccine-associated uveitis led to the detection of pulmonary lesions and lymphadenopathy, resulting in clinical and pathological diagnosis of sarcoidosis. In literature review, 3 patients showed sarcoidosis-like diseases after COVID-19 vaccination: 2 patients were diagnosed clinically as Lofgren syndrome with acute onset of erythema nodosum and ankle swelling, with or without mediastinal and hilar lymphadenopathy, whereas 1 patient with mediastinal lymphadenopathy but no uveitis was diagnosed pathologically by biopsy as sarcoidosis.
11 citations
TL;DR: Four patients infected with SARS‐CoV‐2 presenting with symptomatic cardiac sarcoidosis or giant cell myocarditis 1–8 months after mild COVID‐19 are reported, which might suggest that CO VID‐19 could be a trigger for granulomatousMyocarditis.
Abstract: Patients infected with SARS‐CoV‐2 have varying manifestations of cardiac involvement. We report four patients presenting with symptomatic cardiac sarcoidosis (CS) or giant cell myocarditis (GCM) 1–8 months after mild COVID‐19. All patients received immunosuppressive therapy and improved gradually within the following months. The possible temporal association between the CS/GCM and COVID‐19 infection might suggest that COVID‐19 could be a trigger for granulomatous myocarditis.
2 citations
01 Jan 2023
TL;DR: A broad spectrum of complications following COVID-19 have been documented in adults, including the new onset of autoimmune related manifestations and rheumatic diseases as mentioned in this paper , including rheumatoid arthritis, myositis, antiphospholipid antibodies, ITP, and thyroid dysfunction.
Abstract: A broad spectrum of complications following COVID-19 has been documented in adults, including the new onset of autoimmune-related manifestations and rheumatic diseases. Numerous case studies, reviews, and clinical trials have been published regarding the relationship between COVID-19 and the generation of autoantibodies that may cause rheumatic and autoimmune diseases. The currently suggested pathophysiology that leads to the new onset of such disorders may include well-established mechanisms, such as molecular mimicry and hyperstimulation of the immune system. The prevailing conditions documented following COVID-19 include, yet are not limited to, rheumatoid arthritis, myositis, antiphospholipid antibodies, ITP, and thyroid dysfunction. This chapter will summarize the current documentation of the broad-spectrum rheumatic diseases and autoimmune manifestations mediated by a SARS-CoV-2 infection.
TL;DR: A case of sarcoidosis developing after COVID‐19 is presented as an interesting sequela of SARS‐CoV‐2 without complication, suggesting a possible link between the viral infection and dysregulation of the inflammation process.
Abstract: COVID‐19 has been implicated in the development of a range of autoimmune diseases and medical consequences. Sarcoidosis is an inflammatory disease with sustained granulomatous inflammation. The possible main pathogenesis of sarcoidosis is a dysregulation between immune response and certain environmental antigens. We present a case of sarcoidosis as an interesting sequela of COVID‐19. The patient was hospitalized due to SARS‐CoV‐2 without complication. Ten weeks after the illness, his chest computed tomography (CT) showed bilateral hilar, paratracheal and subcarinal lymph node enlargement. Endobronchial ultrasound with transbronchial needle aspiration (EBUS‐TBNA) was performed; pathologic findings were that of well‐formed non‐necrotizing granulomas. Complete eye examination reported panuveitis and papillitis in both eyes. On the basis of these findings, sarcoidosis was diagnosed. Therefore, sarcoidosis developing after COVID‐19 was suggested as a possible link between the viral infection and dysregulation of the inflammation process. However, further studies are needed to confirm this association.
01 Jan 2023
TL;DR: The long-term impact of the SARS-CoV2 infection on autoimmunity and autoinflammation was investigated in this article , where the authors presented a new approach for shedding new light and unexpected insights on autoimmune/autoinflammatory diseases.
Abstract: The “Severe Acute Respiratory Syndrome-related Coronavirus type 2” (SARS-CoV-2), the infectious agent responsible for the still ongoing “Coronavirus Disease 2019” (COVID-19) pandemic, represents a major environmental trigger and an important piece of the mosaic of autoimmunity and autoinflammation. Several de novo-onset or flares/relapses of autoimmune/autoinflammatory diseases have been reported associated either directly or indirectly with the viral agent. COVID-19 has represented a unique opportunity for shedding new light and unexpected insights on autoimmune/autoinflammatory diseases. These have, in turn, enabled the discovery of novel aspects of the COVID-19 infection, offering already approved, effective and safe drugs, as options to be repurposed in the fight against the novel coronavirus. However, there is still a dearth of information concerning the long-term impact of the virus on autoimmunity and autoinflammation – the so-called long-COVID or postCOVID, which warrants further investigation.
References
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TL;DR: Hospitalised COVID-19 patients are frequently elderly subjects with co-morbidities receiving polypharmacy, all of which are known risk factors for d
Abstract: Background: Hospitalised COVID-19 patients are frequently elderly subjects with co-morbidities receiving polypharmacy, all of which are known risk factors for d
14,343 citations
DOI•
19 Mar 2020
TL;DR: The Director-General of the World Health Organization, Dr. Tedros Adhanom Ghebreyesus, noted that over the past 2 weeks, the number of cases outside China increased 13-fold and theNumber of countries with cases increased threefold, and further increases are expected.
Abstract: The World Health Organization (WHO) on March 11, 2020, has declared the novel coronavirus (COVID-19) outbreak a global pandemic (1). At a news briefing , WHO Director-General, Dr. Tedros Adhanom Ghebreyesus, noted that over the past 2 weeks, the number of cases outside China increased 13-fold and the number of countries with cases increased threefold. Further increases are expected. He said that the WHO is "deeply concerned both by the alarming levels of spread and severity and by the alarming levels of inaction," and he called on countries to take action now to contain the virus. "We should double down," he said. "We should be more aggressive." [...].
4,415 citations
Journal Article•
1,958 citations
TL;DR: There was a wide spectrum of presenting signs and symptoms and disease severity, ranging from fever and inflammation to myocardial injury, shock, and development of coronary artery aneurysms, and comparison with the characteristics of other pediatric inflammatory disorders.
Abstract: Importance In communities with high rates of coronavirus disease 2019, reports have emerged of children with an unusual syndrome of fever and inflammation. Objectives To describe the clinical and laboratory characteristics of hospitalized children who met criteria for the pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (PIMS-TS) and compare these characteristics with other pediatric inflammatory disorders. Design, Setting, and Participants Case series of 58 children from 8 hospitals in England admitted between March 23 and May 16, 2020, with persistent fever and laboratory evidence of inflammation meeting published definitions for PIMS-TS. The final date of follow-up was May 22, 2020. Clinical and laboratory characteristics were abstracted by medical record review, and were compared with clinical characteristics of patients with Kawasaki disease (KD) (n = 1132), KD shock syndrome (n = 45), and toxic shock syndrome (n = 37) who had been admitted to hospitals in Europe and the US from 2002 to 2019. Exposures Signs and symptoms and laboratory and imaging findings of children who met definitional criteria for PIMS-TS from the UK, the US, and World Health Organization. Main Outcomes and Measures Clinical, laboratory, and imaging characteristics of children meeting definitional criteria for PIMS-TS, and comparison with the characteristics of other pediatric inflammatory disorders. Results Fifty-eight children (median age, 9 years [interquartile range {IQR}, 5.7-14]; 20 girls [34%]) were identified who met the criteria for PIMS-TS. Results from SARS-CoV-2 polymerase chain reaction tests were positive in 15 of 58 patients (26%) and SARS-CoV-2 IgG test results were positive in 40 of 46 (87%). In total, 45 of 58 patients (78%) had evidence of current or prior SARS-CoV-2 infection. All children presented with fever and nonspecific symptoms, including vomiting (26/58 [45%]), abdominal pain (31/58 [53%]), and diarrhea (30/58 [52%]). Rash was present in 30 of 58 (52%), and conjunctival injection in 26 of 58 (45%) cases. Laboratory evaluation was consistent with marked inflammation, for example, C-reactive protein (229 mg/L [IQR, 156-338], assessed in 58 of 58) and ferritin (610 μg/L [IQR, 359-1280], assessed in 53 of 58). Of the 58 children, 29 developed shock (with biochemical evidence of myocardial dysfunction) and required inotropic support and fluid resuscitation (including 23/29 [79%] who received mechanical ventilation); 13 met the American Heart Association definition of KD, and 23 had fever and inflammation without features of shock or KD. Eight patients (14%) developed coronary artery dilatation or aneurysm. Comparison of PIMS-TS with KD and with KD shock syndrome showed differences in clinical and laboratory features, including older age (median age, 9 years [IQR, 5.7-14] vs 2.7 years [IQR, 1.4-4.7] and 3.8 years [IQR, 0.2-18], respectively), and greater elevation of inflammatory markers such as C-reactive protein (median, 229 mg/L [IQR 156-338] vs 67 mg/L [IQR, 40-150 mg/L] and 193 mg/L [IQR, 83-237], respectively). Conclusions and Relevance In this case series of hospitalized children who met criteria for PIMS-TS, there was a wide spectrum of presenting signs and symptoms and disease severity, ranging from fever and inflammation to myocardial injury, shock, and development of coronary artery aneurysms. The comparison with patients with KD and KD shock syndrome provides insights into this syndrome, and suggests this disorder differs from other pediatric inflammatory entities.
1,449 citations
Centers for Disease Control and Prevention1, University of Miami2, New York City Department of Health and Mental Hygiene3, Harvard University4, Broad Institute5, University of Southern Maine6, United States Department of Health and Human Services7, Maine Medical Center8, Louisiana State University9, Veterans Health Administration10, Emory University11, United States Department of Energy12
TL;DR: Clinicians and health departments should consider MIS-A in adults with compatible signs and symptoms, and interventions that prevent COVID-19 might prevent MIS-B, as well as the role for antibody testing in identifying similar cases among adults.
Abstract: During the course of the coronavirus disease 2019 (COVID-19) pandemic, reports of a new multisystem inflammatory syndrome in children (MIS-C) have been increasing in Europe and the United States (1-3). Clinical features in children have varied but predominantly include shock, cardiac dysfunction, abdominal pain, and elevated inflammatory markers, including C-reactive protein (CRP), ferritin, D-dimer, and interleukin-6 (1). Since June 2020, several case reports have described a similar syndrome in adults; this review describes in detail nine patients reported to CDC, seven from published case reports, and summarizes the findings in 11 patients described in three case series in peer-reviewed journals (4-6). These 27 patients had cardiovascular, gastrointestinal, dermatologic, and neurologic symptoms without severe respiratory illness and concurrently received positive test results for SARS-CoV-2, the virus that causes COVID-19, by polymerase chain reaction (PCR) or antibody assays indicating recent infection. Reports of these patients highlight the recognition of an illness referred to here as multisystem inflammatory syndrome in adults (MIS-A), the heterogeneity of clinical signs and symptoms, and the role for antibody testing in identifying similar cases among adults. Clinicians and health departments should consider MIS-A in adults with compatible signs and symptoms. These patients might not have positive SARS-CoV-2 PCR or antigen test results, and antibody testing might be needed to confirm previous SARS-CoV-2 infection. Because of the temporal association between MIS-A and SARS-CoV-2 infections, interventions that prevent COVID-19 might prevent MIS-A. Further research is needed to understand the pathogenesis and long-term effects of this newly described condition.
405 citations