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Pulmonary sarcoid‐like granulomatosis induced by nivolumab
Author(s) -
Montaudié H.,
Pradelli J.,
Passeron T.,
Lacour J.P.,
Leroy S.
Publication year - 2017
Publication title -
british journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.304
H-Index - 179
eISSN - 1365-2133
pISSN - 0007-0963
DOI - 10.1111/bjd.14808
Subject(s) - nivolumab , medicine , sarcoidosis , pembrolizumab , melanoma , lung cancer , bronchoalveolar lavage , adverse effect , cancer , immunotherapy , pathology , oncology , lung , gastroenterology , cancer research
Summary The use of antibodies against programmed death ( PD )1, such as nivolumab and pembrolizumab, has dramatically improved the prognosis of patients with advanced melanoma. Nivolumab is also approved in advanced squamous cell nonsmall‐cell lung cancer. These immunotherapies are associated with a unique set of toxicities termed immune‐related adverse events, which are different from toxicities observed with conventional cytotoxic chemotherapy. We report the case of a 56‐year‐old man who was diagnosed with metastatic melanoma and who received nivolumab. One week after the second infusion, he developed pulmonary symptoms, dry eye syndrome and a bilateral swelling of the parotid glands. Investigations were negative for infection. The bronchoalveolar lavage differential cell count showed 32% lymphocytes with an increased CD 4 : CD 8 ratio, and bronchial biopsies revealed noncaseating epithelioid granulomas, without malignant cells. The clinical and radiological courses were rapidly favourable with oral corticosteroid. This case illustrates that sarcoidosis can be induced by nivolumab treatment. With the increasing use of anti‐ PD 1 inhibitors in patients with advanced melanoma and squamous cell nonsmall‐cell lung cancer, clinicians should be aware of this potential associated immune‐related adverse event.