Presentation
Previous history of metastatic melanoma. No fevers or raised septic markers.
Patient Data
Extensive areas of consolidation and groundglass opacities with a relatively symmetrical distribution involving mostly the upper lobes. No pleural effusion. The airways are unremarkable.
There are two tiny subcutaneous nodules in the medial aspect of the right breast. Extensive bone metastatic disease.
This patient was not clinically septic and the pattern of consolidation/groundglass is relatively symmetrical. On review of her medical history, she has started immunotherapy 2 months ago for her advanced metastatic melanoma.
Her previous chest imaging was normal (following study - chest radiograph).
The lungs and pleural spaces are clear, the mediastinal contours are within the normal limits.
Immunotherapy has been withheld and, some weeks later, the lungs have improved and there are some residual perihilar upper lobes infiltrates.
A few months later, the lungs have mostly cleared, but a small right pleural effusion has developed and now multiple liver metastases are seen.
Case Discussion
This case illustrates the impressive appearances that immunotherapy-induced pneumonitis can have on imaging.
The patient was receiving anti-PD1 (nivolumab) to treat her advanced metastatic melanoma.
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