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CASE REPORT article
Front. Immunol.
Sec. Cancer Immunity and Immunotherapy
Volume 16 - 2025 | doi: 10.3389/fimmu.2025.1432927
This article is part of the Research Topic Sarcoidosis Diagnosis and Treatment Based on Etiology View all 3 articles
Case report: The immune architecture of immunotherapy-induced cutaneous sarcoidosis resembles peritumoral inflammation
Provisionally accepted
Catherine J Wang 1
Jennifer Strong 1
Margaret E Gatti-Mays 2
Houssein Abdul Sater 3 Julius Strauss 2
Jason M Redman 2,3
Jeffrey Schlom 2
James L. Gulley 3
Isaac Brownell 1,3*- 1 Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIH), Bethesda, Maryland, United States
- 2 Laboratory of Tumor Immunology and Biology, Center for Cancer Research, National Cancer Institute (NIH), Bethesda, Maryland, United States
- 3 Genitourinary Urinary Malignancies Branch, National Cancer Institute (NIH), Bethesda, Maryland, United States
Avelumab, is an anti-PD-L1 immune checkpoint inhibitor (ICI). Like other ICI, avelumab can cause immune-related adverse events. Although rare, sarcoidosis-like granulomatous reactions have been described in patients on anti-CTLA-4 and anti-PD-1 immunotherapy. Here we report a case of treatment emergent cutaneous sarcoidosis in a patient who received avelumab for metastatic colon cancer. A 56-year-old African American woman with metastatic colon cancer that had progressed after multiple lines of treatment, including other immunotherapy agents, was enrolled on a clinical trial with avelumab. While on treatment, the patient developed two skin lesions, and histopathological examination of both biopsies demonstrated chronic granulomatous inflammation in the dermis with multinucleated giant cells containing asteroid bodies, consistent with cutaneous sarcoidosis. Multiplex immunofluorescence revealed parallels between the immune architecture of the patient’s cutaneous sarcoidal lesion and an excised tumor metastasis. Recognizing cutaneous sarcoidosis as a rare adverse effect of ICI immunotherapy is important because sarcoidal lesions can be mistaken for metastatic disease on clinical exam and medical imaging. We noticed similar immune composition of the sarcoidal granuloma and tumor microenvironment. However, further studies are needed to fully elucidate the mechanism of ICI associated sarcoidosis.
Keywords: Immunotherapy, anti-PD-L1, avelumab, Cutaneous sarcoidosis, Immune-related adverse event, case report
Received: 15 May 2024; Accepted: 10 Feb 2025.
Copyright: © 2025 Wang, Strong, Gatti-Mays, Abdul Sater, Strauss, Redman, Schlom, Gulley and Brownell. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Isaac Brownell, Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIH), Bethesda, 20892-3675, Maryland, United States
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