Sarcoidosis detected after COVID-19 with T-SPOT.TB positive: A case report

Sarcoidosis is an idiopathic multisystem disorder with unknown etiology. Due to clinical similarities among sarcoidosis, tuberculosis (TB) infection and malignant diseases (such as lymphoma, lung carcinoma and pituitary tumor), the diagnosis of sarcoidosis is challenging. The present report describes a case of sarcoidosis in a 48-year-old male with complaint of chest pain 1 month after Coronavirus disease 2019. The patient underwent whole-body 18F-fluorodeoxyglucose (18F-FDG) PET-CT imaging, which revealed multiple lymphadenopathies throughout the body without lung parenchyma involvement. Biochemical examinations such as T-SPOT.TB test and pathological examination of right supraclavicular lymph node revealed positive T-SPOT.TB but negative Ziehl-Neelsen staining. However, non-caseating epithelioid granulomas were observed in the mediastinal biopsy, indicating the diagnosis of sarcoidosis. The patient was clinically stable, and the symptom of chest pain was gradually relieved without any specific treatment. Outpatient follow-up continued every 3 months. The present case suggested a possible link between coronavirus infection and sarcoidosis, which suggests the advantages of 18F-FDG PET-CT for the detection of sarcoidosis. However, T-SPOT.TB is insufficient for differentiating between sarcoidosis and TB.