Copyright
©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
Drug-induced sarcoidosis-like reaction three months after BNT162b2 mRNA COVID-19 vaccination: A case report and review of literature
Soo Ryang Kim, Soo Ki Kim, Takako Fujii, Hisato Kobayashi, Toyokazu Okuda, Takanobu Hayakumo, Atsushi Nakai, Yumi Fujii, Ryuji Suzuki, Noriko Sasase, Aya Otani, Yu-ichiro Koma, Motoko Sasaki, Tsutomu Kumabe, Osamu Nakashima
Soo Ryang Kim, Soo Ki Kim, Takako Fujii, Toyokazu Okuda, Takanobu Hayakumo, Atsushi Nakai, Yumi Fujii, Department of Gastroenterology, Kobe Asahi Hospital, Kobe 6530801, Hyogo, Japan
Hisato Kobayashi, Department of Radiology, Kobe Asahi Hospital, Kobe 6530801, Hyogo, Japan
Ryuji Suzuki, Department of Clinical Laboratory, Kobe Asahi Hospital, Kobe 6530801, Hyogo, Japan
Noriko Sasase, Aya Otani, Department of Pharmacy, Kobe Asahi Hospital, Kobe 6530801, Hyogo, Japan
Yu-ichiro Koma, Division of Pathology, Department of Pathology, Kobe University Graduate School of Medicine, Kobe 6530801, Hyogo, Japan
Motoko Sasaki, Department of Human Pathology, Kanazawa University Graduate School of Medicine, Kanazawa 9208640, Ishikawa, Japan
Tsutomu Kumabe, Department of Gastroenterology, Kumabe Clinic, Kumamoto 8611331, Kumamoto, Japan
Osamu Nakashima, Laboratory Services Center, St. Mary's Hospital, Kurume 830-8543, Fukuoka, Japan
Author contributions: Kim SK conceived the case and wrote the manuscript; Kim SR observed the clinical course of the patient and made the figures; Fujii T, Okuda T, Fujii Y, Hayakumo T, Nakai A, Suzuki R, Sasase N, and Otani A observed the clinical course of the patient; Kobayashi H and Kumabe T conducted the radiological examinations and interpreted the imaging findings; Koma YI, Sasaki M, and Nakashima O conducted histological examinations.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Soo Ki Kim, MD, PhD, Director, Doctor, Department of Gastroen
terology, Kobe Asahi Hospital, 3-5-25, Bououji-cho, Nagata-ku, Kobe 6530801, Hyogo, Japan.
kinggold@kobe-asahi-hp.com
Received: September 13, 2022
Peer-review started: September 13, 2022
First decision: October 14, 2022
Revised: October 21, 2022
Accepted: December 19, 2022
Article in press: December 19, 2022
Published online: January 6, 2023
Processing time: 113 Days and 23.5 Hours
BACKGROUND
A 70-year-old man with hepatitis C virus-related recurrent hepatocellular carcinoma was admitted for further diagnosis of a 1 cm iso-hyperechoic nodule in segment (S) 5.
CASE SUMMARY
Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (EOB-MRI) revealed the nodule in S5 with a defect at the hepatobiliary phase, hyperintensity on diffusion weighted imaging (DWI) and hypointensity on apparent diffusion coefficient (ADC) map. Contrast-enhanced computed tomography revealed hypervascularity at the early phase, and delayed contrast-enhancement was observed at the late phase. Contrast-enhanced ultrasound (US) revealed incomplete defect at the late vascular phase. Inflammatory liver tumor, lymphoproliferative disease, intrahepatic cholangiocarcinoma (small duct type) and bile duct adenoma were suspected through the imaging studies. US guided biopsy, however, showed a noncaseating hepatic sarcoid-like epithelioid granuloma (HSEG), and histopathological analysis disclosed spindle shaped epithelioid cells harboring Langhans-type multinucleated giant cells. One month after admission, EOB-MRI signaled the disappearance of the defect at the hepatobiliary phase, of hyperintensity on DWI, of hypointensity on ADC map, and no stain at the early phase.
CONCLUSION
That the patient had received BNT162b2 messenger RNA (mRNA) coronavirus disease 2019 vaccination 3 mo before the occurrence of HSEG, and that its disappearance was confirmed 4 mo after mRNA vaccination suggested that the drug-induced sarcoidosis-like reaction (DISR) might be induced by the mRNA vaccination. Fortunately, rechallenge of drug-induced DISR with the third mRNA vaccination was not confirmed.
Core Tip: We describe a case of drug-induced sarcoidosis-like reaction (DISR) a noncaseating hepatic sarcoid-like epithelioid granuloma (HSEG). Histopathological analysis disclosed, characteristic spindle-shaped epithelioid cells harboring Langhans-type multinucleated giant cells. Two months and 5 mo after the third BNT162b2 messenger RNA (mRNA) coronavirus disease 2019 vaccination, the occurrence of HSEG was not confirmed before rechallenging the drug-induced DISR by the third mRNA vaccination.
