title: New-onset mediastinal and central nervous system sarcoidosis in a patient with metastatic melanoma undergoing CTLA4 monoclonal antibody treatment.
abstract: BACKGROUND
  Ipilimumab, a cytotoxic monoclonal antibody that inhibits cytotoxic T lymphocyte-associated antigen-4 (CTLA-4), has been established as an effective therapy in the management of advanced melanoma. Immune-mediated adverse events are a common side effect.
  
  
  METHODS
  A 37-year-old male patient was diagnosed with nodal and osseous metastatic melanoma 15 months after the initial surgical treatment for lower limb melanoma. Therapy with the anti-CTLA-4 antibody, ipilimumab, was started. Follow-up staging imaging after treatment initiation showed symmetrical bihilar adenopathy. Transbronchial biopsy showed sarcoidosis. The patient had associated systemic symptoms of fatigue, joint pains, anorexia and weight loss. Brain magnetic resonance imaging (MRI), which was performed for the investigation of headaches, showed abnormal enhancing tissue in the sella turcica and adjacent to the pituitary infundibulum, consistent with neurosarcoidosis. The condition was successfully treated with corticosteroids.
  
  
  CONCLUSIONS
  We report a case of immunotherapy-induced mediastinal/hilar sarcoidosis, with pituitary involvement, mimicking tumour progression. This highlights the need for awareness amongst radiologists and oncologists of the mechanism of action and potential side effects of new immunotherapies.
authors.affiliation: Department of Radiology, Cork University Hospital, Ireland.
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Murphy
authors.forename: Marcus P
authors.initials: MP
authors.lastname: Kennedy
authors.forename: Josephine E
authors.initials: JE
authors.lastname: Barry
authors.forename: Kevin N
authors.initials: KN
authors.lastname: O'Regan
authors.forename: Derek G
authors.initials: DG
authors.lastname: Power
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000911:Antibodies, Monoclonal / Q000009:adverse effects* / Q000276:immunology / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000276:immunology / Q000627:therapeutic use; D001168:Arthritis; D001859:Bone Neoplasms / Q000188:drug therapy* / Q000556:secondary; D060908:CTLA-4 Antigen / Q000037:antagonists & inhibitors* / Q000276:immunology; D002493:Central Nervous System Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D000074324:Ipilimumab; D008297:Male; D008477:Mediastinal Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D008545:Melanoma / Q000188:drug therapy* / Q000556:secondary; D012507:Sarcoidosis / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D012878:Skin Neoplasms / Q000188:drug therapy / Q000473:pathology; D013585:Synovitis; D016896:Treatment Outcome; D014605:Uveitis; D056660:Hereditary Autoinflammatory Diseases
chemical_list: D000305:Adrenal Cortex Hormones; D000911:Antibodies, Monoclonal; D000970:Antineoplastic Agents; D060908:CTLA-4 Antigen; C556706:CTLA4 protein, human; D000074324:Ipilimumab