Cisplatin-induced sarcoidosis-like reaction after primary chemoradiotherapy for locally advanced cervical cancer

A woman in her mid-40s presented with post-coital bleeding and a squamous cell carcinoma of the cervix was identified. Initial investigation identified a primary fluorodeoxyglucose positron emission tomography (FDG PET)-avid lesion and avid external iliac lymph nodes (stage IIIC1). She was planned for primary chemoradiation treatment with curative intent.Treatment included external beam radiation therapy, brachytherapy and weekly cisplatin. A follow-up FDG PET found a partial metabolic response within the cervix. It also identified interval development of FDG-avid lymph nodes in the periportal lymphatics in the abdomen, mediastinal and bilateral hilar lymph nodes, 8 vertebrae and iliac bones. Biopsy confirmation was attempted and hilar lymph nodes were suggestive of granulomatous inflammation.A final diagnosis of cisplatin-induced sarcoidosis-like reaction was made. No treatment was initiated. A follow-up FDG PET 3 months later found ongoing response of the primary lesion and complete resolution of the reactive sarcoidosis-like reaction.