Fig. 4.

ICI induced sarcoid-like reaction. Dry cough and progressive dyspnea on exertion developed in this 45-year-old man, 4 months after initiating combination Nivolumab and Ipilimumab for urothelial carcinoma. Chest CT demonstrated markedly enlarged bilateral hilar and mediastinal lymph nodes (c, d, arrows) when compared to baseline (a, b). Biopsies of the lymph nodes revealed noncaseating granulomas with no evidence of malignancy. Cultures and AFB smears of bronchoalveolar lavage fluid were negative. ICI therapy was withheld and systemic steroids were initiated for presumed ICI-induced sarcoidosis. Complete resolution of symptoms was reported after completion of 8 weeks of steroid therapy. A repeat chest CT 10 weeks after completion of steroids demonstrated regression of the mediastinal and hilar lymphadenopathy (e, f)