Post-COVID-19 Recurrent Oropharyngeal Lesions Mediated by Atypical Vasculitis, an Autoimmune Condition, or Infection: A Case Report

TL;DR

A rare case of recurring oropharyngeal lesions after COVID-19 is described, possibly linked to atypical vasculitis, an autoimmune condition, or infection.

Contribution

This case report presents a rare and complex post-COVID-19 condition with atypical vasculitis or autoimmune features not well-documented in the literature.

Findings

The patient experienced recurrent oropharyngeal lesions over five years following a two-month COVID-19 infection.

Biopsies and tests showed inconclusive results, including fungal growth but no malignancy.

The case was attributed to atypical vasculitis, an autoimmune condition, or a rare infection.

Abstract

Post-COVID-19 complications have been widely identified since the pandemic began in 2019. Among these complications are immune-mediated conditions, including vasculitis, Kawasaki-like disease, and IgA vasculitis. Typically, vasculitis presents with classical features such as rash, shortness of breath, joint problems, visual problems, fibrinoid necrosis, and granulomas.

Here, we present a rare and complex case of atypical vasculitis, immunological response, or an autoimmune condition, which posed significant diagnostic challenges and required input from a multidisciplinary team (MDT). Although the literature includes cases of COVID-19-associated complications, the combination of presentation symptoms and findings in this case is not well-documented in the literature.

Our patient was a 46-year-old female who presented to the emergency department on multiple occasions starting in 2021 after contracting COVID-19 for nearly two months. She presented again in 2023 and 2024 with similar episodes. Despite these multiple presentations, her
diagnosis remained unclear for five years until she presented in 2024 with left neck pain, progressive dysphagia, and hemoptysis.

The case was further complicated by systemic involvement as she developed small bilateral lower lung lobe peripheral emboli with no evidence of DVT or any other thrombus during her prolonged hospital stay. Biopsies and laboratory investigations were inconclusive, often showing fungal growth (Candida albicans and glabrata) and excluding malignancy.

After extensive discussions, the case was deemed to represent atypical vasculitis, an autoimmune condition, or an infection with a very rare and complex presentation. This case highlights that recurrent oropharyngeal and pharyngeal lesions following COVID-19 infection could indicate these possibilities, even in the absence of classical symptoms.

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