Division of Hematology/Oncology, Lifespan Health System, Providence, Rhode Island, USA
Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA.
BMJ Case Rep. 2021 Dec 7;14(12):e247278. doi: 10.1136/bcr-2021-247278.
Sarcoidosis is a granulomatous disease that commonly presents with lung or lymphatic system manifestations. Diagnosis is often delayed due to variable clinical presentation. This is a case of a patient with metastatic clear cell ovarian cancer who developed disease reoccurence after definitive treatment with surgery and adjuvant chemotherapy. She was treated with multiple lines of therapy, including investigational agents. During this time, she developed mediastinal lymphadenopathy and hypercalcaemia. Due to suspicion that her presentation was not a manifestation of her malignancy, she underwent two lymph node biopsies revealing granulomatous disease. She was initiated on prednisone for management of sarcoidosis, which led to radiologic, laboratory and symptomatic improvement. Although the precipitating factor for this patient's sarcoidosis cannot be definitively determined, nivolumab is a possible culprit. This case highlights the importance of a broad differential diagnosis when a patient undergoing antineoplastic treatment develops mediastinal lymphadenopathy or hypercalcaemia.
结节病是一种肉芽肿性疾病，常表现为肺部或淋巴系统表现。由于临床表现多样，诊断常常被延误。这是一例转移性透明细胞卵巢癌患者，在接受手术和辅助化疗的确定性治疗后复发疾病。她接受了多种治疗线，包括研究性药物。在此期间，她出现了纵隔淋巴结病和高钙血症。由于怀疑她的表现不是恶性肿瘤的表现，她接受了两次淋巴结活检，结果显示为肉芽肿性疾病。她开始接受泼尼松龙治疗结节病，这导致影像学、实验室和症状改善。尽管无法明确确定导致该患者结节病的诱发因素，但纳武单抗可能是一个罪魁祸首。这个病例强调了在接受抗肿瘤治疗的患者出现纵隔淋巴结病或高钙血症时，需要进行广泛的鉴别诊断。
