Sarcoidal reaction following COVID-19 infection

A 79-year-old man, previously well, fully immunised with AstraZeneca COVID-19 vaccine and boosted twice with a Pfizer mRNA vaccine, presented on 3 September 2022 with sore throat, fever (39°C), malaise, myalgia and cough. He tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) on a rapid antigen test. He was commenced the following day on nirmatrelvir and ritonavir. Because of persistent cough, a chest X-ray was performed 2 months later and showed minor lingular lobe atelectasis. Non-contrast chest computed tomography (CT) demonstrated patchy ground-glass changes in both lungs, extensive mediastinal lymphadenopathy and a cluster of prominent right supraclavicular nodes. Six weeks later, the mediastinal lymphadenopathy was unchanged on chest CT with contrast, the largest node measuring 16 mm. The lungs were clear apart from dependent ground-glass opacities in the bases. The only abnormalities on biochemical and haematological screening were erythrocyte sedimentation rate 20 mm/h (1–12), estimated glomerular filtration rate 76 mL/min/1.73 m2 (>90) (unchanged from 2 years previously) and minimally increased globulin 41 g/L (25–40).