Immunotherapy-Induced Sarcoid-Like Reaction: A Shrewd Imitator

Immunotherapy-Induced Sarcoid-Like Reaction: A Shrewd Imitator

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A 40-year-old male with a right-sided neck mass was diagnosed with metastatic melanoma.A repeat positron-emission tomography after treatment with combination immunotherapy demonstrated increased hypermetabolic activity in the right supraclavicular, hilar, and mediastinal regions.Immunotherapy was discontinued and a BRAF/MEK inhibitor combination was started.Repeat imaging showed a decrease in size of the neck mass; however, hilar and mediastinal lymph nodes increased in size.A here fine needle aspiration of mediastinal lymph nodes was consistent with a granulomatous process.

A diagnosis of a sarcoid-like reaction (SLR) was made, and he was started on steroids.A follow-up positron emission tomography showed decreased hilar and mediastinal lymph node hypermetabolic activity.We, therefore, report this rare case of immunotherapy-induced SLR to the expanding literature on immunotherapy-related adverse effects and would like to highlight that SLR can occur in conjunction with disease progression making chicago cubs earrings it challenging to distinguish between the two.