Sarcoidosis and COVID-19: At the Cross-Road between Immunopathology and Clinical Manifestation

Abstract

Coronavirus disease 2019 (COVID-19) has been associated with dysregulation of the immune system featuring inappropriate immune responses, exacerbation of inflammatory responses, and multiple organ dysfunction syndrome in patients with severe disease. Sarcoidosis, also known as Besnier–Boeck–Schaumann disease, is an idiopathic granulomatous multisystem disease characterized by dense epithelioid non-necrotizing lesions with varying degrees of lymphocytic inflammation. These two diseases have similar clinical manifestations and may influence each other at multiple levels, eventually affecting their clinical courses and prognosis. Notably, sarcoidosis patients are at high risk of severe COVID-19 pneumonia because of the underlying lung disease and chronic immunosuppressive treatment. In this narrative review, we will discuss interactions between sarcoidosis and COVID-19 in terms of clinical manifestations, treatment, and pathogenesis, including the role of the dysregulated renin–angiotensin system, altered immune responses involving increased cytokine levels and immune system hyperactivation, and cellular death pathways.

Subacute hemorrhagic pericardial tamponade after COVID-19 infection mimicking carcinomatous pericarditis: a case report

“…Although the exact etiology and mechanism of sarcoidosis remain poorly understood, plausible mechanisms include hyperinflammatory immune-mediated responses to an antigen against infectious or environmental exposures. Previous studies have proposed a possible signal crosstalk between COVID-19 and sarcoidosis, which shared cell signaling pathways such as renin-angiotensin signaling, inhibited autophagy, and induced cell apoptosis ( 20 ). Similarly, COVID-19 might have induced sarcoid-like reaction in the lymph nodes in our case.…”

Sarcoidosis Presenting as a Lung Mass in a Patient With COVID-19 Infection: A Case Report

“…Sarcoidosis is a multisystemic disease that is characterized by hallmark histopathological features of noncaseating granulomas [1]. It rarely presents as a dominant nodular mass or as discrete nodules that resemble cancer or infection [5].…”

“…Increased immunoreactivity is a hallmark of both coronavirus disease 2019 (COVID-19) infection and sarcoidosis. Additionally, very less is known about the clinical and immune interaction between COVID-19 and sarcoidosis [1]. Sarcoidosis is a multisystemic disease characterized by non-caseating epithelioid granulomas which appear as nodules formed by inflammatory cells in different organs.…”

Pathophysiological, immunological, and inflammatory features of long COVID

“…Evidence indicates that patients exhibiting these manifestations display altered immune mediators, both cellular and humoral, with a notable focus on modified T-cell populations ( 21 , 104 , 108 ). It is plausible to hypothesize that these altered populations may contribute to persistent immunopathology, potentially accounting for long-term symptoms characterized by inflammation, such as chronic fever and muscle and joint pain ( 20 , 164 , 311 , 312 ). However, it is crucial to emphasize that the connection between acute and chronic immune regulation post-SARS-CoV-2 infection is not yet fully elucidated.…”