Sarcoidosis-like reaction induced by immune checkpoint inhibitors in patients with advanced melanoma: A report of two cases and a brief review of the literature
Introduction. Immunotherapy is associated with a wide range of adverse events. A drug-induced sarcoidosis-like reaction is a systemic granulomatous reaction that is no different from sarcoidosis and occurs in a certain temporal relationship with the initiation of the drug. Case report. The first pre...
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Ministry of Defence of the Republic of Serbia, University of Defence, Belgrade
2025-01-01
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| Series: | Vojnosanitetski Pregled |
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| Online Access: | https://doiserbia.nb.rs/img/doi/0042-8450/2025/0042-84502400080D.pdf |
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| author | Dujović Branko Kandolf Lidija Radević Tatjana Petrov Nenad Mijušković Željko |
| author_facet | Dujović Branko Kandolf Lidija Radević Tatjana Petrov Nenad Mijušković Željko |
| author_sort | Dujović Branko |
| collection | DOAJ |
| description | Introduction. Immunotherapy is associated with a wide range of adverse events. A drug-induced sarcoidosis-like reaction is a systemic granulomatous reaction that is no different from sarcoidosis and occurs in a certain temporal relationship with the initiation of the drug. Case report. The first presented patient was a 61-year-old male with stage IIIC BRAF-positive melanoma treated with adjuvant nivolumab therapy. After four cycles of therapy, enlarged mediastinal lymph nodes were confirmed using computed tomography. Bronchoscopy with bronchoalveolar lavage and transbronchial biopsy showed chronic granulomatous inflammation. After 12 cycles, grouped brownish-red papules and plaques covered with whitish scales were observed in the skin of both knees, and a histopathology finding indicated a sarcoidosis-like reaction. He was treated with oral prednisone, 60 mg daily in decreasing doses, and after 16 months, the enlarged mediastinal lymph nodes and skin lesions disappeared completely. The second presented patient was a 45-year-old male with stage IIIC BRAF-positive melanoma treated with adjuvant pembrolizumab therapy. After four cycles, enlarged mediastinal lymph nodes were observed. Bronchoscopy with bronchoalveolar lavage revealed granulomatous inflammation, and transbronchial biopsy confirmed sarcoidosis. Therapy with oral prednisone 40 mg daily in decreasing doses was performed in the next three months, and immunotherapy was continued. The enlarged mediastinal lymph nodes resolved after completion of adjuvant therapy. Conclusion. In most cases, a diagnosis of a sarcoidosis-like reaction requires a biopsy of the suspected lesions. It is not usually necessary to stop immunotherapy, but sometimes standard corticosteroid therapy is indicated. An interdisciplinary approach is important to distinguish true disease progression from adverse drug reaction. |
| format | Article |
| id | doaj-art-c4dc01caf52647a3b7ae1e942f1fae60 |
| institution | OA Journals |
| issn | 0042-8450 2406-0720 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Ministry of Defence of the Republic of Serbia, University of Defence, Belgrade |
| record_format | Article |
| series | Vojnosanitetski Pregled |
| spelling | doaj-art-c4dc01caf52647a3b7ae1e942f1fae602025-08-20T02:02:30ZengMinistry of Defence of the Republic of Serbia, University of Defence, BelgradeVojnosanitetski Pregled0042-84502406-07202025-01-01821465310.2298/VSP240726080D0042-84502400080DSarcoidosis-like reaction induced by immune checkpoint inhibitors in patients with advanced melanoma: A report of two cases and a brief review of the literatureDujović Branko0https://orcid.org/0009-0009-1497-5777Kandolf Lidija1https://orcid.org/0000-0002-5221-5068Radević Tatjana2https://orcid.org/0000-0001-9259-3031Petrov Nenad3Mijušković Željko4https://orcid.org/0000-0003-0924-1719Military Medical Academy, Department of Dermatology and Venereology, Belgrade, Serbia + University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, SerbiaMilitary Medical Academy, Department of Dermatology and Venereology, Belgrade, Serbia + University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, SerbiaMilitary Medical Academy, Department of Dermatology and Venereology, Belgrade, Serbia + University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, SerbiaMilitary Medical Academy, Center of Pathology and Forensic Medicine, Belgrade, SerbiaMilitary Medical Academy, Department of Dermatology and Venereology, Belgrade, Serbia + University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, SerbiaIntroduction. Immunotherapy is associated with a wide range of adverse events. A drug-induced sarcoidosis-like reaction is a systemic granulomatous reaction that is no different from sarcoidosis and occurs in a certain temporal relationship with the initiation of the drug. Case report. The first presented patient was a 61-year-old male with stage IIIC BRAF-positive melanoma treated with adjuvant nivolumab therapy. After four cycles of therapy, enlarged mediastinal lymph nodes were confirmed using computed tomography. Bronchoscopy with bronchoalveolar lavage and transbronchial biopsy showed chronic granulomatous inflammation. After 12 cycles, grouped brownish-red papules and plaques covered with whitish scales were observed in the skin of both knees, and a histopathology finding indicated a sarcoidosis-like reaction. He was treated with oral prednisone, 60 mg daily in decreasing doses, and after 16 months, the enlarged mediastinal lymph nodes and skin lesions disappeared completely. The second presented patient was a 45-year-old male with stage IIIC BRAF-positive melanoma treated with adjuvant pembrolizumab therapy. After four cycles, enlarged mediastinal lymph nodes were observed. Bronchoscopy with bronchoalveolar lavage revealed granulomatous inflammation, and transbronchial biopsy confirmed sarcoidosis. Therapy with oral prednisone 40 mg daily in decreasing doses was performed in the next three months, and immunotherapy was continued. The enlarged mediastinal lymph nodes resolved after completion of adjuvant therapy. Conclusion. In most cases, a diagnosis of a sarcoidosis-like reaction requires a biopsy of the suspected lesions. It is not usually necessary to stop immunotherapy, but sometimes standard corticosteroid therapy is indicated. An interdisciplinary approach is important to distinguish true disease progression from adverse drug reaction.https://doiserbia.nb.rs/img/doi/0042-8450/2025/0042-84502400080D.pdfbiopsydiagnosisdifferentialdisease progressiondrug-related side effects and adverse reactionsmelanomasarcoidosis |
| spellingShingle | Dujović Branko Kandolf Lidija Radević Tatjana Petrov Nenad Mijušković Željko Sarcoidosis-like reaction induced by immune checkpoint inhibitors in patients with advanced melanoma: A report of two cases and a brief review of the literature Vojnosanitetski Pregled biopsy diagnosis differential disease progression drug-related side effects and adverse reactions melanoma sarcoidosis |
| title | Sarcoidosis-like reaction induced by immune checkpoint inhibitors in patients with advanced melanoma: A report of two cases and a brief review of the literature |
| title_full | Sarcoidosis-like reaction induced by immune checkpoint inhibitors in patients with advanced melanoma: A report of two cases and a brief review of the literature |
| title_fullStr | Sarcoidosis-like reaction induced by immune checkpoint inhibitors in patients with advanced melanoma: A report of two cases and a brief review of the literature |
| title_full_unstemmed | Sarcoidosis-like reaction induced by immune checkpoint inhibitors in patients with advanced melanoma: A report of two cases and a brief review of the literature |
| title_short | Sarcoidosis-like reaction induced by immune checkpoint inhibitors in patients with advanced melanoma: A report of two cases and a brief review of the literature |
| title_sort | sarcoidosis like reaction induced by immune checkpoint inhibitors in patients with advanced melanoma a report of two cases and a brief review of the literature |
| topic | biopsy diagnosis differential disease progression drug-related side effects and adverse reactions melanoma sarcoidosis |
| url | https://doiserbia.nb.rs/img/doi/0042-8450/2025/0042-84502400080D.pdf |
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