Iodine-131
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Cutaneous sarcoidosis: case report. A 50-year-old woman developed cutaneous sarcoidosis during treatment with iodine-131 for thyroid cancer. The woman was hospitalised for the evaluation of subcutaneous nodules. At the end of November 2018, she had undergone lymph node dissection with a total thyroidectomy for a follicular variant papillary carcinoma (pT2N1bM0). She had negative positron emission tomography (PET) for disease extension. In January 2019, she had started receiving radioactive iodine-131 [route not stated]. On the day following the initiation of iodine-131, she developed several progressive subcutaneous nodules bilaterally on all four limbs as well as at the abdominal level. Additionally, she had a diffuse arthralgia mostly on the feet and an episode of shivering. The woman was treated with unspecified non-steroidal anti-inflammatory drugs and had a modest improvement. In April 2019, she presented for further assessment (current presentation). She had history of high BP, type 2 non-insulin-dependent diabetes mellitus and hypercholesterolaemia. She had surgical history for a secreting adrenal adenoma and liposarcoma of the thigh performed in 2012. Her medications included amlodipine, metformin [Glucophage], allopurinol, perindopril, levothyroxine sodium [levothyroxine], rosuvastatin and hydrocortisone. The evolution since the onset of the symptoms was rather favourable with a progressive decline in joint pain. Her skin lesions were persistent but without pain. Physical examination revealed approximately 2cm straight and indurated lateral cervical lymphadenopathy as well as approximately 1 to 2cm multiple subcutaneous nodules, which were painless with normal skin in sight. The lesions were on all the four limbs as well as at the abdominal level. The rest of the physical examination was normal. The blood examination revealed no inflammatory syndrome. Haemogram revealed an isolated lymphopenia with 1100 lymphocytes/mm³. She had hypercalcaemia of 2.67 mmol/L. Several other investigations were unremarkable. Skin biopsy demonstrated mononuclear inflammatory infiltrate at the hypodermic level with many histiocytes forming granulomatous epithelioid nodules, which were sometimes necrotising. A dense lymphocytic crown were surrounding these granulomas. Additional microbiological examinations were unremarkable. A PET scan revealed right latero-cervical hypermetabolic lymphadenopathy, multifocal mediastinal adenopathies and hypermetabolic subcutaneous lesions. A chest scan confirmed the presence of mediastinal lymphadenopathies, with no parenchymal involvement. Endobronchial ultrasound did not reveal any granulomas or neoplastic cells. On the basis of her history, a cervical lymph node puncture was performed, revealing thyroid origin neoplastic cells. She was diagnosed with cutaneous sarcoidosis with recurrence of the cancerous disease at the cervical level. Considering the low clinical impact and the absence of any pulmonary involvement, she was not treated for the sarcoidosis. Subcutaneous nodules gradu
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