A Case of Cutaneous Sarcoid-like Granuloma Induced by Nivolumab for Pharyngeal Cancer

Abstract

We here describe a rare case of sarcoid-like granuloma arising in a male patient with pharyngeal cancer during nivolumab therapy. Ten weeks after introduction of nivolumab, the patient developed pruritic erythematous plaques on his trunk; and histopathological examination revealed non-caseating epithelioid granulomas in the dermis. No other organs such as the lungs, eyes, and heart were involved, and serum levels of angiotensin converting enzymes were normal. The skin lesions were well controlled by use of topical corticosteroids without systemic corticosteroid treatment or nivolumab discontinuation. However, the patient later developed hypothyroidism and increased serum amylase levels suggestive of acute pancreatitis, so nivolumab was finally discontinued. Among cutaneous immune-related adverse events, sarcoid-like granuloma is rare. In the current report, we also review previous reports on cutaneous sarcoidosis/sarcoid-like granuloma and discuss the possible mechanism of the induction of sarcoid-like granuloma during immune checkpoint inhibitor therapy.