Antineoplastics/folinic acid
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Sarcoidosis-like reaction: case report An adult man in his 60s [exact age not stated] developed sarcoidosis-like reaction following treatment with oxaliplatin, folinic acid, fluorouracil and bevacizumab for metastatic colorectal cancer. The man, who was diagnosed with stage IVB metastatic colon adenocarcinoma 12 months prior, presented with obstructive bowel symptoms, 40 pounds weight loss and a change in stool calibre at the age of 54 years. Further, positron emission tomography (PET) CT scan, colonoscopy and biopsy revealed liver and peritoneal metastasis. Subsequently, he underwent extended left colectomy, right partial hepatectomy, resection of the right diaphragm nodule and cholecystectomy. A gene sequencing revealed a mutation significant for Kirsten rat sarcoma. Post-surgery, he received 6 cycles of a combination chemotherapy regimen comprising bevacizumab along with oxaliplatin, fluorouracil [5-fluorouracil] and folinic acid [dosages and routes not stated] with excellent partial response. In addition, he underwent cytoreductive surgery, exploratory laparotomy and omentectomy. Thereafter, he received six additional cycles of chemotherapy. However, a surveillance PET-CT scan 6 months following completion of the chemotherapy showed bilateral hilar lymphadenopathy with scattered splenic and hepatic lesions. Subsequent PET-CT scan indicated that these lesions metabolically active. Further, non-caseating granulomas were observed on endobronchial ultrasound bronchoscopy (EBUS) of the right paratracheal and interlobar lymph nodes. Anamnesis revealed that he had lived in USA all his life and had no travel history to foreign countries. An elevation in serum calcium and angiotensin-converting enzyme (ACE) levels were also noted. However, he was asymptomatic. Hence, further intervention was not considered. A CT scan performed 3 months later showed resolution of the hepatosplenic lesions and lymphadenopathy. Subsequently, his serum calcium and ACE levels also normalised. Based on these findings, the diagnosis of sarcoidosis-like reaction secondary to the chemotherapy was confirmed. Surveillance CT scans over the next 18 months showed absence of hepatosplenic lesions and lymphadenopathy. Aedma SK, et al. Oxaliplatin-associated sarcoid-like reaction masquerading as recurrent colon cancer. BMJ Case Reports 13: No. 9, 2020. Available from: URL: http:// 803506158 doi.org/10.1136/bcr-2019-229548
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Reactions 10 Oct 2020 No. 1825
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