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drug-induced sarcoidosis-like reaction three months after BNT162b2 mRNA COVID-19 vaccination:A case report and review of literature

引用

World Journal of Clinical Cases 2023年第1期11卷 177-186页

作者： 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 Department of Gastroenterology Kobe Asahi HospitalKobe 6530801HyogoJapan Department of Radiology Kobe Asahi HospitalKobe 6530801HyogoJapan Department of Clinical Laboratory Kobe Asahi HospitalKobe 6530801HyogoJapan Department of Pharmacy Kobe Asahi HospitalKobe 6530801HyogoJapan Division of Pathology Department of PathologyKobe University Graduate School of MedicineKobe 6530801HyogoJapan Department of Human Pathology Kanazawa University Graduate School of MedicineKanazawa 9208640IshikawaJapan Department of Gastroenterology Kumabe ClinicKumamoto 8611331KumamotoJapan Laboratory Services Center St.Mary's HospitalKurume 830-8543FukuokaJapan

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.

关键词： drug-induced sarcoidosis-like reaction BNT162b2 mRNA COVID-19 vaccine Noncaseating granuloma Ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging Th1/Th2 profile Case report

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