Sarcoidosis With COVID-19

Several  post-COVID-19  inflammatory  disorders  and  autoimmune  diseases  have  been  discovered [1]  since  global  COVID-19  pandemic  started [2].  Association  between  these  diseases  is  still  to  be  investigated [2].  Common  genes  between  COVID-19  and  sarcoidosis  are  demonstrated  in  Figure 1, 2 [3].  Nevertheless, sarcoidosis  organ  involvement, demographics, and  type  of  sarcoidosis  treatment  at  the  time  of  COVID-19  diagnosis  are  related  to  hospital  admission, non-invasive  ventilation  or  high  flow  oxygenation, intubation [4].   A  retrospective  hospital-based  cohort  study  of  585  French  sarcoidosis  patients  in  2017, demonstrated  an  estimate  of  a  5 %  frequency  of  severe  infections  that  resulting  in  hospital  admission  and  death [5].  A typical HRCT feature in sarcoidosis is the presence of well-defined micronodules scattered along the broncho-vascular bundle, veins, fissures and pleura in a characteristic lymphatic distribution. Occasionally, “ galaxy  sign ”,a  highly  suggestive  of  pulmonary  sarcoidosis (predominance  of  a  mid-to-upper  lung  zones)  may  demonstrates  conglomerate masses that  are surrounded by a multitude of micronodules (Figure  3) [6].

Where VDR dominantly connected to 14 different kinds of drug, protein drug interaction network collected from DrugBank  provides  proper  treatment. Vitamin D and some of its analogous compounds might play significant roles in modulating both COVID-19 and sarcoidosis conditions  is  indicated  by  this  network (Figure  4) [3].

Besides  sarcoidosis  of  lungs, symptomatic  and  accidental  extrapulmonary  sarcoidosis  is  also  found  around  the  world (Figure  5, 6, 7) [7-9]. 

In  conclusion, hub  gene  identification  might  have  significant  roles  in  modulating  sarcoidosis  and  COVID-19  infection.  In  the  literature, cases  with  sarcoid-like  granuloma  have  been  reported  very  few.  Sarcoid-like  immune  response  to  COVID-19  could  be  noncaseating  granulomas  due  to  short  time  from  disease  to  develop  granuloma. 

Figure  1 :  Demonstrating  a Venn diagram of commonly differentially expressed upregulated genes. Common 34 upregulated genes were identified from 2320 upregulated genes of COVID-19 infection and 227 upregulated genes of sarcoidosis [3].

Figure  2 :  Demonstrating  protein-protein interactions (PPIs) network for common upregulated genes from COVID-19 and sarcoidosis. The light green color nodes indicate common upregulated genes. Network consists of 32 nodes and 102 edges [3].

Figure  3  :  Demonstrating  irregularly marginated nodule surrounded by multiple small nodules (“Galaxy sign”, yellow narrow), this is typical of sarcoidosis (a); ground-glass-like increased attenuation resulting from diffuse micronodules randomly distributed (“Miliary sarcoidosis”) (b); enlarged and partially calcified (yellow narrows) bilateral hilar lymph nodes (c); fibrotic sarcoidosis with cystic changes and traction bronchiectases (yellow narrows) predominantly in the perihilar region and upper lobes. Nodular abnormalities are minimal/absent, but the appearance and the location of the fibrosis are very suggestive of the diagnosis of sarcoidosis (d) [6].

Figure  4 :  Demonstrating  drugs protein interaction network [3].

Figure  5  :  Demonstrating  isolated  muscular  sarcoidosis, revealed by hypercalcemia and ¹⁸F-FDG PET/CT [7].

Figure  6  :  ¹⁸F-FDG PET/MRI for Diagnosis and Treatment Efficacy Evaluation of Spinal Sarcoidosis [8].

Figure  7 :  Demonstrating  FDG PET of Isolated Right Ventricular Sarcoidosis [9].

References

1. Galeotti  C, Baryl  J.  Autoimmune  and  inflammatory  diseases  following  COVID-19.  Nat  Rev  Rheumatol  2020; 16 (8) : 413-414. 

2. Racil  H, Znegui  T, Maazoui  S, Touil  A, Habibech  S, Henda  N, et  al.  Can  coronavirus  disease  2019  induce  sarcoidosis : a  case  report.  Thorac  Res  Pract  2023; 24 (1) : 45-48. 

DOI : 10.5152/.ThoracResPract.2023.22076

3. Mogal  R, Sovupa  SA, Junayed  A, Mahmod  R, Abedin  Z, Sikder  S.  Common  genetic  aspects  between  COVID-19  and  sarcoidosis : a  network-based  approach  using  expression  data.  Biochemistry  and  Biophysics  Reports  2022; 29 : 101219. 

4. Nadeem  O, Sharma  A, Alaouie  D, Bradley  P, Ouellette  D.  Outcome  in  patients  with  sarcoidosis  diagnosed  with  COVID-19.  Presentation  at  Chest  2021  annual  meeting, October  2021, 17-20.

DOI :  https://doi.org/10.1016/j.chest.2021.07.1161  

5. Dureault  A, Chapelon  C, Biard  L, et  al.  Severe  infections  in  sarcoidosis : incidence, predictors  and  long-term  outcome  in  a  cohort  of  585  patients.  Medicine (Baltimore)  2017; 96 : e8846.

6. Bernardinello N, Petrarulo S, Balestro E, Cocconcelli E, Veltkamp M, Spagnolo P. Pulmonary Sarcoidosis: Diagnosis and Differential Diagnosis. Diagnostics (Basel). 2021 Aug 28;11(9):1558.

DOI : 10.3390/diagnostics11091558.  

7. Dhomps  A, Thibault  F, Streichenberger  N, Andrea  S, Jeremie  T. Isolated  muscular  sarcoidosis  revealed  by  hypercalcemia.  Clinical Nuclear Medicine 44(10):p 824-825, October 2019.

DOI: 10.1097/RLU.0000000000002678

8. Ashjan K, Darejan  B, Lea  F, Mathilde  H, Vincent  P, Imperiale, Alessio I. 18F-FDG PET/MRI for diagnosis and treatment efficacy evaluation of spinal sarcoidosis.  Clinical Nuclear Medicine 49(1):p e28-e30, January 2024. DOI: 10.1097/RLU.0000000000004968

9. Alan S, Dagmar  HS.  FDG PET of Isolated Right Ventricular Sarcoidosis.  Clinical Nuclear Medicine 48(2):p 184-185, February 2023. DOI: 10.1097/RLU.00000000000044013