Marshall University, Huntington, WV, USA.
J Investig Med High Impact Case Rep. 2021 Jan-Dec;9:23247096211009400. doi: 10.1177/23247096211009400.
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 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 it challenging to distinguish between the two.
一位 40 岁男性因右侧颈部肿块被诊断为转移性黑色素瘤。在接受联合免疫治疗后进行的重复正电子发射断层扫描显示，右侧锁骨上、肺门和纵隔区域的代谢活性增加。免疫治疗被停止，开始使用 BRAF/MEK 抑制剂联合治疗。重复成像显示颈部肿块大小减小；然而，肺门和纵隔淋巴结增大。纵隔淋巴结的细针抽吸与肉芽肿过程一致。诊断为类肉瘤样反应（SLR），并开始使用类固醇治疗。后续的正电子发射断层扫描显示肺门和纵隔淋巴结的高代谢活性降低。因此，我们将这例罕见的免疫治疗引起的 SLR 报告给不断扩展的免疫治疗相关不良反应文献，并强调 SLR 可与疾病进展同时发生，使得两者难以区分。
