Pokhriyal Sindhu C, Nabeel Pasha Muhammad, Khan Ahmad, Uwiringiyimana Rosine, Idris Hadeeqa
Internal Medicine, One Brooklyn Health, New York City, USA.
Pulmonary and Critical Care Medicine, One Brooklyn Health, New York City, USA.
Cureus. 2023 May 17;15(5):e39136. doi: 10.7759/cureus.39136. eCollection 2023 May.
Coronavirus disease 2019 (COVID-19) is a viral infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which is known to be associated with immune dysregulation and can cause multiorgan dysfunction. Sarcoidosis is another disease associated with increased inflammatory responses due to immune dysregulation which can also affect multiple organs. Although sarcoidosis, like COVID-19 infection, can affect virtually any organ, the lungs are the most commonly affected organs. Sarcoidosis most commonly presents as lung nodules and bilateral hilar lymphadenopathy. Rarely, multiple granulomatous lesions can coalesce and manifest as lung masses, and these often mimic lung cancer. We present a case of a 64-year-old male who presented with shortness of breath and pneumonia-like symptoms for one week and a nasopharyngeal swab for SARS-CoV-2 was positive. Workup revealed a large 6.3×4.7 cm lung mass in the right upper lobe along with enlarged bilateral lymph nodes. A CT-guided lung biopsy was done which revealed non-caseating granulomas containing epithelioid cells. Other causes of granuloma like tuberculosis and fungal infections were ruled out. The patient was managed with low-dose steroids and a follow-up CT scan done after eight months revealed complete resolution of lung mass with minimal mediastinal lymphadenopathy. This is, as far as we are aware, the first case of COVID-19 infection manifesting as a lung mass that was ultimately diagnosed as sarcoidosis.
2019冠状病毒病（COVID-19）是一种由严重急性呼吸综合征冠状病毒2（SARS-CoV-2）引起的病毒感染，已知与免疫失调有关，并可导致多器官功能障碍。结节病是另一种由于免疫失调导致炎症反应增加的疾病，也可影响多个器官。尽管结节病与COVID-19感染一样，几乎可累及任何器官，但肺部是最常受累的器官。结节病最常见的表现为肺结节和双侧肺门淋巴结肿大。罕见情况下，多个肉芽肿性病变可融合并表现为肺肿块，且这些肿块常酷似肺癌。我们报告一例64岁男性患者，他出现气短和类似肺炎的症状一周，鼻咽部SARS-CoV-2拭子检测呈阳性。检查发现右上叶有一个6.3×4.7 cm的大肺肿块，同时双侧淋巴结肿大。进行了CT引导下的肺活检，结果显示为含有上皮样细胞的非干酪样肉芽肿。排除了其他肉芽肿病因，如结核病和真菌感染。该患者接受低剂量类固醇治疗，八个月后进行的随访CT扫描显示肺肿块完全消退，纵隔淋巴结肿大轻微。据我们所知，这是首例表现为肺肿块最终被诊断为结节病的COVID-19感染病例。
