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Mediastinal FDG-positive lymph nodes simulating melanoma progression: drug-induced sarcoidosis like/lymphadenopathy related to ipilimumab
  1. Carlos González-Cruz1,2,
  2. Domingo Bodet1,2,
  3. Eva Muñoz-Couselo2,3 and
  4. Vicente García-Patos1,2
  1. 1Dermatology, Hospital Vall d'Hebron, Barcelona, Spain
  2. 2Universitat Autònoma de Barcelona, Barcelona, Spain
  3. 3Oncology, Hospital Vall d'Hebron, Barcelona, Catalunya, Spain
  1. Correspondence to Dr Carlos González-Cruz; carlos.gonzalez{at}vhebron.net

Abstract

Drug-induced sarcoidosis-like reactions (DISRs) are systemic granulomatous diseases that develop in the context of a new drug onset. Ipilimumab is an immune checkpoint inhibitor (ICI) approved for the treatment of advanced melanoma which has been associated with DISR. Differential diagnosis between tumour progression and DISR by positron emission tomography/computed tomography (PET/CT) in patients treated with an ICI can be a challenge. A 31-year-old woman was diagnosed with a stage IIIB melanoma in her back. Ipilimumab 10 mg/kg was initiated. After 1 month of finishing the treatment a routine, PET/CT showed multiple enlarged mediastinal and hilar lymph nodes FDG-positive. A transbronchial biopsy showed sarcoid-like granulomatous infiltration which favoured the diagnosis of DISR related to ipilimumab. The patient remained asymptomatic and lymphadenopathy regressed progressively after 11 months. Our work highlights the importance of differentiating DISR from tumour progression, before unnecessary changes in therapeutic strategies. PET/CT is a useful diagnostic tool for its follow-up.

  • dermatology
  • radiology (diagnostics)
  • drugs and medicines
  • immunological products and vaccines
  • skin cancer

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Footnotes

  • Twitter @carlos_gocr

  • Contributors We declare that this is an original and non-previously published paper, and all persons who have made substantial contributions to the work reported in the manuscript including writing and editing assistance have given me written permission. CG-C made substantial contributions to the conception and design of the work, the acquisition, analysis and interpretation of data. He drafted the work. He approved the final version published. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. DB, EM-C and VG-P made substantial contributions to the conception and design of the work, the acquisition, analysis and interpretation of data. They revised the work critically for important intellectual content. They approved the final version published. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

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

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