Sarcoid Reactions after Chemotherapy for Hodgkin's Lymphoma

There is a reported association between sarcoidosis and malignancy. This is particularly true for lymphomas and is known as the sarcoidosis-lymphoma syndrome.

A 49 year old Caucasian female presented with mediastinal and axillary lymphadenopathy. An excisional axillary lymph node biopsy showed classical Hodgkin's lymphoma, nodular sclerosis subtype. She received six cycles of conventional chemotherapy achieving a complete remission with no evidence of any lymphadenopathy on restaging imaging. However, one month after completion of chemotherapy, she developed new onset of progressive mediastinal lymphadenopathy. A mediastinoscopy and biopsy was performed showing noncaseating granulomata and the patient was diagnosed with a sarcoid reaction.

Sarcoidosis and sarcoid reactions must be considered in the differential diagnosis when assessing patients with persistent or enlargening masses after chemotherapy treatment for Hodgkin's lymphoma, especially since this is associated with a better prognosis. A tissue biopsy is essential prior to starting chemotherapy for presumed relapsed malignancy or persistent disease so as to avoid inappropriate treatment.