title: Sarcoidosis in the setting of combination ipilimumab and nivolumab immunotherapy: a case report & review of the literature.
abstract: BACKGROUND
  We report a case of sarcoidosis in a patient with metastatic melanoma managed with combination ipilimumab/nivolumab. Sarcoid development has been linked with single agent immunotherapy but, to our knowledge, it has not been reported with combination ipilimumab/nivolumab treatment. This case raises unique management challenges for both the melanoma and the immunotherapy-related toxicity.
  
  
  METHODS
  A 46 year old Caucasian female with M1c-metastatic melanoma was managed with ipilimumab/nivolumab combination. Patient experienced response in baseline lesions but developed new clinical and radiographic findings. Biopsy of new lesions at two different sites both demonstrated tumefactive sarcoidosis. Staining of the biopsy tissue for PD-L1 expression demonstrated strong PD-L1 staining of the histiocytes and lymphocytes within the granulomas. Monotherapy nivolumab was continued without progression of sarcoid findings or clinical deterioration.
  
  
  CONCLUSIONS
  Tissue biopsy for evaluation of new lesions on immunotherapy is an important step to help guide decision making, as non-melanoma lesions can mimic disease progression.
authors.affiliation: Department of Medicine, Division of Hematology-Oncology, University of Virginia Health System, PO Box 800716, Charlottesville, 22908 VA USA.
authors.forename: Joshua E
authors.initials: JE
authors.lastname: Reuss
authors.affiliation: Department of Medicine, Division of Hematology-Oncology, University of Virginia Health System, PO Box 800716, Charlottesville, 22908 VA USA.
authors.forename: Paul R
authors.initials: PR
authors.lastname: Kunk
authors.affiliation: Department of Pathology, Division of Anatomic Pathology, University of Virginia Health System, PO Box 800716, Charlottesville, 22908 VA USA.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Stowman
authors.affiliation: Department of Pathology, Division of Anatomic Pathology, University of Virginia Health System, PO Box 800716, Charlottesville, 22908 VA USA.
authors.forename: Alejandro A
authors.initials: AA
authors.lastname: Gru
authors.affiliation: Department of Surgery, Division of Surgical Oncology, University of Virginia Health System, PO Box 800716, Charlottesville, 22908 VA USA.
authors.forename: Craig L
authors.initials: CL
authors.lastname: Slingluff
authors.affiliation: Department of Medicine, Division of Hematology-Oncology, University of Virginia Health System, PO Box 800716, Charlottesville, 22908 VA USA.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Gaughan
keywords: Checkpoint inhibitor; Combination immunotherapy; Immune-related adverse event; Ipilimumab; Metastatic melanoma; Nivolumab; Sarcoidosis