Elevated serum ACE levels in patients with post-acute COVID-19 syndrome, 2022, Mitchell et al

richie · May 14, 2025 at 1:00 PM

2022 paper

Elevated serum ACE levels in patients with post-acute COVID-19 syndrome | QJM: An International Journal of Medicine | Oxford Academic

(no abstract)

Hutan · May 14, 2025 at 12:44 PM

First, one case:

Pertinently, a major feature of active sarcoidosis is fatigue experienced by up to 80% of those affected. Sarcoidosis-associated fatigue is globally recognized as a severely disabling symptom.9 Sarcoidosis is associated with an elevated serum angiotensin converting enzyme (ACE) level.10 Here, we report on a patient with PACS (not hospitalized and did not require supplemental oxygen) causing severe fatigue, ‘brain fog’ and dyspnoea 5 months after his initial acute COVID-19 infection. The patient underwent several tests including a serum ACE level and a computed tomography (CT) chest (Figure 1 below). The serum ACE was elevated at 121 µ/l—normal 0–65 µ/l.
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The endobronchial biopsy (see Figure 1A below) demonstrated non-necrotizing granulomas consistent with a sarcoid-like reaction.
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Hutan · May 14, 2025 at 12:47 PM

Then, 28/124 PACs patients had elevated serum ACE:

We measured serially serum ACE in 124 patients seen at our PACS outpatient clinic. Patients were seen due to unresolving symptoms such as fatigue, dyspnoea and ‘brain fog’. All patients had previously confirmed PCR positive acute COVID-19 acute infection a mean of 4 months previously. Twenty-eight (22.6%) of subjects were found to have an elevated serum ACE level where samples were obtained > 3 months post-acute COVID-19 infection (m = 84.2, SD = 15.9). Ninety-six (77.6%) of subjects had a normal serum ACE level (m = 42.5, SD =13.5). Serum ACE is elevated in ∼40–60% of patients with sarcoidosis. It is only elevated in ∼2–3% or normal healthy people.
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Hutan · May 14, 2025 at 9:24 PM

I have only been tested for ACE twice. Once about 10 months after onset. The reported level was high-normal (48 with a normal range of 8 to 52). And then more than 10 years after onset when it was high (above normal) but went unremarked by my GP (I don't have the number to hand).

This paper did not find ACE elevated:
Preprint: The SARS-CoV-2 receptor angiotensin-converting enzyme 2 (ACE2) in [ME/CFS].., 2021, Malato et al
although it quotes an old paper that did.

richie · May 14, 2025 at 4:49 PM

Hutan said: ↑

I have only been tested for ACE twice. Once about 10 months after onset. The reported level was high-normal (48 with a normal range of 8 to 52). And then more than 10 years after onset when it was high but went unremarked by my GP (I don't have the number to hand).

This paper did not find ACE elevated:
Preprint: The SARS-CoV-2 receptor angiotensin-converting enzyme 2 (ACE2) in [ME/CFS].., 2021, Malato et al
although it quotes an old paper that did.
Click to expand...

Perhaps sb on here would be able to comment on ACE elevation not derived from granuloma. It may be that you did have a granulomatous episode. Have you had any scans? I may have had it since childhood or symptom onset in 1985 but too late to say now. Assumed that I have it now at low grade.

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Elevated serum ACE levels in patients with post-acute COVID-19 syndrome, 2022, Mitchell et al

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