CTICasesImmunotherapy-Induced Sarcoid-Like Reaction
Imaging findings
CT chest in a patient undergoing immunotherapy for melanoma shows a rapid development of numerous, tiny centrilobular nodules clusterd together, creating a ground-glass appearance, associated with extensive hilar and mediastinal lymphadenopathy. Biopsy confirmed non-caseating granulomas.
Key takeaways
Immune checkpoint inhibitors (such as anti-PD-1 or anti-CTLA-4 agents) can trigger a sarcoid-like granulomatous reaction in the lungs and mediastinal lymph nodes. When the nodules are extremely small and packed together, they can manifest as ground-glass opacities rather than discrete nodules, mimicking progressive metastatic disease.
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