2019年冠状病毒病(COVID-19)是由严重急性呼吸道综合征冠状病毒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。结节病是另一种与由于免疫失调引起的炎症反应增加相关的疾病,其也可以影响多个器官。虽然结节病,比如COVID-19感染,几乎可以影响任何器官,肺部是最常见的器官。结节病最常表现为肺结节和双侧肺门淋巴结肿大。很少,多发性肉芽肿性病变可合并并表现为肺部肿块,这些经常模仿肺癌。我们介绍了一例64岁的男性,该男性出现呼吸急促和肺炎样症状持续一周,而SARS-CoV-2的鼻咽拭子呈阳性。检查显示右上叶有一个6.3×4.7cm的大肺肿块,并伴有双侧淋巴结肿大。进行了CT引导的肺活检,发现含有上皮样细胞的非干酪样肉芽肿。排除了其他引起肉芽肿的原因,例如结核和真菌感染。患者接受了低剂量类固醇治疗,八个月后进行的随访CT扫描显示,肺部肿块完全消退,纵隔淋巴结肿大。这是,据我们所知,第一例COVID-19感染表现为肺肿块,最终被诊断为结节病。
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.