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Pembrolizumab-induced Sarcoid-like Reactions during Treatment of Metastatic Melanoma

Sophie C Cheshire1, Ruth E Board1, Alexandra R Lewis1

  • 1From the Departments of Radiology (S.C.C., M.J.D.), Oncology (R.E.B., A.R.L.), and Cellular Pathology (L.D.G.), Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Sharoe Green Lane North, Fulwood, Preston, PR2 9HT, England.

Radiology
|August 15, 2018
PubMed

Insights

Pembrolizumab immunotherapy can cause sarcoid-like reactions in melanoma patients. Awareness of this association is crucial for accurate diagnosis, distinguishing it from metastatic disease.

Area of Science:

  • Oncology
  • Immunology
  • Radiology

Background:

  • Pembrolizumab, a programmed cell death protein 1 (PD-1) inhibitor, is an immunotherapy used for advanced melanoma.
  • Malignant melanoma treatment often involves complex immunotherapies with potential side effects.

Observation:

  • Three patients with metastatic melanoma treated with pembrolizumab developed mediastinal and hilar lymphadenopathy.
  • Histologic examination confirmed these findings represented a sarcoid-like reaction, not metastatic disease.

Findings:

  • Pembrolizumab therapy is associated with the development of sarcoid-like reactions.
  • Radiographic findings of lymphadenopathy can mimic metastatic disease.

Implications:

  • Radiologists and clinicians must recognize this association to avoid misdiagnosis.
  • Diagnosis involves clinical presentation, biopsy, imaging (bilateral hilar lymphadenopathy), and elevated angiotensin-converting enzyme levels.
  • Proper diagnosis prevents unnecessary treatment escalation or changes in oncologic management.

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