CTICasesPembrolizumab-Associated Sarcoid-like Reaction
Imaging findings
In a patient with melanoma treated with pembrolizumab, chest CT shows a combination of small nodular and ground-glass attenuating opacities diffusely distributed throughout all lobes; biopsy showed non-necrotizing granulomas, and after withdrawal of pembrolizumab the findings improved substantially on follow-up imaging.
Key takeaways
This represents an immunotherapy checkpoint-inhibitor-associated sarcoid-like granulomatous reaction, a recognized drug reaction to PD-1/PD-L1 inhibitors such as pembrolizumab, and previously reported with nivolumab, that mimics sarcoidosis radiologically and histologically but is a distinct drug-related phenomenon that improves with drug cessation; similar granulomatous drug reactions have also been described with TNF-alpha inhibitors, and the case highlights the importance of correlating imaging findings with checkpoint-inhibitor therapy in oncology patients.
AI-assisted summary — may contain errors. Verify against the source video. Learn more
More from this webinar
- Relapsing PolychondritisAutoimmune
- Hepatopulmonary SyndromeVascular
- Pulmonary TuberculosisInfection
- Purpureocillium lilacinum Cavitary Pulmonary InfectionInfection
- Angioinvasive Mucormycosis (Rhizopus) with Aspergillus Co-infectionInfection
- Apical Opacity of Proto (Subclavian Artery Pseudotumor)Artifact
- Fibrotic Hypersensitivity Pneumonitis (Indeterminate for UIP Pattern)ILD
- Amplatzer Amulet Left Atrial Appendage Occlusion DeviceArtifact
See all cases from March 30, 2018 →
Related Inflammatory cases
- Constrictive Pericarditis with Circumferential Pericardial Calcification
- Idiopathic Acute Eosinophilic Pneumonia
- Necrotizing Granulomatous Pulmonary Nodules Following Rituximab Withdrawal
- Pseudo-sequestration (Acquired Systemic Arterialization of the Lung)
- Allergic Bronchopulmonary Aspergillosis
- Pulmonary Hyalinizing Granuloma