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新型冠状病毒感染后结节病所致肉芽肿性间质性肾炎:一例罕见病例报告

Granulomatous interstitial nephritis due to sarcoidosis following SARS-CoV-2 infection: a rare case report.

作者信息

Otani Megumi, Nagahama Kiyotaka, Nakamura Kento, Nagatomo Akiko, Yoshida Suzu, Okai Kazuhiro, Suzuki Ayaka, Sasaki Masato, Hirasawa Suguru, Aki Shota, Tanaka Hiroyuki

机构信息

Department of Nephrology, Yokosuka Kyosai Hospital, 1-16 Yonegahamadori, Yokosuka, Kanagawa, 238-8558, Japan.

Department of Pathology, Kyorin University School of Medicine, Mitaka, Japan.

出版信息

CEN Case Rep. 2025 Jun 16. doi: 10.1007/s13730-025-01008-y.

Abstract

We report the first documented case of renal sarcoidosis developing after SARS-CoV-2 infection. The patient, a 59-year-old woman with no significant medical history, was diagnosed with COVID-19 after experiencing persistent fatigue and insomnia. Approximately three weeks after the infection, she developed a skin rash, prompting a biopsy that revealed epithelioid granulomas. A systemic evaluation using computed tomography identified enlarged bilateral hilar lymph nodes, and a needle aspiration biopsy confirmed the presence of epithelioid granulomas, leading to a diagnosis of sarcoidosis. Nine months after recovering from COVID-19, she was referred to the nephrology department due to progressive renal dysfunction. A renal biopsy demonstrated granulomatous interstitial nephritis with Schaumann bodies, consistent with renal sarcoidosis. Treatment with prednisolone (30 mg/day, 0.5 mg/kg/day) resulted in significant improvement in renal function, suggesting a potential link between SARS-CoV-2 infection and immune dysregulation. This case highlights the importance of monitoring renal function in patients with post-COVID-19 sarcoidosis, even in the absence of disease progression in other organs.

摘要

我们报告了首例有记录的新型冠状病毒感染后发生肾结节病的病例。该患者为一名59岁女性,无重大病史,在经历持续疲劳和失眠后被诊断为新冠肺炎。感染后约三周,她出现皮疹,活检显示为上皮样肉芽肿。计算机断层扫描进行的全身评估发现双侧肺门淋巴结肿大,针吸活检证实存在上皮样肉芽肿,从而诊断为结节病。从新冠肺炎康复九个月后,她因进行性肾功能不全被转诊至肾内科。肾活检显示为伴有舒曼小体的肉芽肿性间质性肾炎,符合肾结节病。泼尼松龙治疗(30毫克/天,0.5毫克/千克/天)使肾功能显著改善,提示新型冠状病毒感染与免疫失调之间可能存在联系。该病例强调了在新冠肺炎后结节病患者中监测肾功能的重要性,即使其他器官无疾病进展。

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