BMJ Case Reports 2016; doi:10.1136/bcr-2016-216217

Systemic sarcoidosis first manifesting in a tattoo in the setting of immune checkpoint inhibition

  1. Arlene Siefker-Radtke
  1. The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  1. Correspondence to Charissa Kim, ckim4{at}
  • Accepted 12 October 2016
  • Published 26 October 2016


The use of immune checkpoint inhibitors is revolutionising the treatment of cancer. However, their unique toxicity profile is substantially different from what has been observed with traditional chemotherapy, resulting in a novel learning curve for medical oncologists. Early recognition of these toxicities can make a substantial impact in ameliorating these side effects in the oncological and medical–surgical fields. Here, we present a case of Lofgren syndrome sarcoidosis, which first manifested in a tattoo in a patient with metastatic urothelial cancer on therapy with anti-CTLA-4 (ipilimumab) and anti-PD1 (nivolumab).


  • Contributors CK was involved in following the patient treatment and contributed to gathering patient information, drafting the patient course, discussion, summary, background and references. AS-R was the primary oncologist and contributed to patient consent, summary, case presentation and treatment. JG contributed to case background, discussion and references. VRS was the pulmonary internist and contributed to patient care, differential diagnosis, discussion and gathering patient information.

  • Funding CK is funded by the National Center for Advancing Translational Sciences of the National Institutes of Health (under Award Numbers TL1TR000369 and UL1TR000371) and the American Legion Auxiliary (ALA). ASR is funded by the National Cancer Institute Specialized Programs of Excellence grant P50 CA091846, the Genitourinary Cancers Program of the CCSG shared resources at the MD Anderson Cancer Center (P30CA16672), the Andrea Hovsepian and Arsen Sohigian Fund for Urothelial Cancer Reserch, and the Michael and Sherry Sutton Fund for Urothelial Cancer Research.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Register for free content

The full text of all Editor's Choice articles and summaries of every article are free without registration

The full text of Images in ... articles are free to registered users

Only fellows can access the full text of case reports (apart from Editor's Choice) - become a fellow today, or encourage your institution to, so that together we can grow and develop this resource

Don't forget to sign up for content alerts so you keep up to date with all the case reports as they are published, and let us know what you think by commenting on the Editor's blog

Navigate This Article