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Sudden Development of Subcutaneous Nodules Shortly after Radioiodine Treatment for Thyroid Cancer Caused by Self-Limiting Sarcoidosis

BACKGROUND: Sarcoidosis is a multisystemic disease producing non-caseating granulomas. The aetiology and pathogenesis are unknown. We herewith report an atypical case of cutaneous sarcoidosis. CASE PRESENTATION: A 50-year-old female presented with an onset of multiple subcutaneous nodules on her 4 l...

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Autores principales: Zaher, Wael, Place, Sammy, Gombeir, Yannick
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SMC Media Srl 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7417045/
https://www.ncbi.nlm.nih.gov/pubmed/32789128
http://dx.doi.org/10.12890/2020_001621
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author Zaher, Wael
Place, Sammy
Gombeir, Yannick
author_facet Zaher, Wael
Place, Sammy
Gombeir, Yannick
author_sort Zaher, Wael
collection PubMed
description BACKGROUND: Sarcoidosis is a multisystemic disease producing non-caseating granulomas. The aetiology and pathogenesis are unknown. We herewith report an atypical case of cutaneous sarcoidosis. CASE PRESENTATION: A 50-year-old female presented with an onset of multiple subcutaneous nodules on her 4 limbs. These nodules appeared concomitantly with the initiation of radioactive iodine therapy for papillary thyroid cancer. These nodules were not obvious on inspection of the skin, but easily felt on palpation. The biopsy of the subcutaneous nodules revealed hypodermic non-caseating granulomas consistent with sarcoidosis. The patient underwent an 18F-fluorodeoxyglucose positron emission tomography (PET) scan study that revealed, besides the subcutaneous nodules, multiple hypermetabolic mediastinal lymphadenopathies and cervical adenopathies. Biopsy of the mediastinal lymphadenopathy showed neither granulomas nor neoplastic cells. Cervical biopsy revealed neoplastic cells of thyroid origin. Laboratory tests were normal. Bronchoalveolar lavage showed a normal CD4/CD8 T-cell ratio. A diagnosis of cutaneous sarcoidosis was established, as well as a recurrence of the cancerous disease. The subcutaneous nodules regressed spontaneously in the absence of any treatment. DISCUSSION AND CONCLUSION: Sarcoidosis is a multisystemic disease of unknown origin. This case illustrates an uncommon occurrence of sarcoidosis, triggered by radioactive iodine therapy. Radioiodine may lead to immunological changes, especially affecting the Th1/Th2 ratio, which may promote the emergence of sarcoidosis in genetically predisposed patients. There is still much to discover to fully understand the pathogenesis of sarcoidosis. LEARNING POINTS: The immunopathogenesis of sarcoidosis is poorly understood, as well as the environmental factors involved. Radioactive iodine therapy for thyroid cancer treatment may be an environmental trigger. The immunological changes induced by radioiodine, especially with respect to the Th1/Th2 ratio, may promote occurrence of sarcoidosis in genetically predisposed patients.
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spelling pubmed-74170452020-08-11 Sudden Development of Subcutaneous Nodules Shortly after Radioiodine Treatment for Thyroid Cancer Caused by Self-Limiting Sarcoidosis Zaher, Wael Place, Sammy Gombeir, Yannick Eur J Case Rep Intern Med Articles BACKGROUND: Sarcoidosis is a multisystemic disease producing non-caseating granulomas. The aetiology and pathogenesis are unknown. We herewith report an atypical case of cutaneous sarcoidosis. CASE PRESENTATION: A 50-year-old female presented with an onset of multiple subcutaneous nodules on her 4 limbs. These nodules appeared concomitantly with the initiation of radioactive iodine therapy for papillary thyroid cancer. These nodules were not obvious on inspection of the skin, but easily felt on palpation. The biopsy of the subcutaneous nodules revealed hypodermic non-caseating granulomas consistent with sarcoidosis. The patient underwent an 18F-fluorodeoxyglucose positron emission tomography (PET) scan study that revealed, besides the subcutaneous nodules, multiple hypermetabolic mediastinal lymphadenopathies and cervical adenopathies. Biopsy of the mediastinal lymphadenopathy showed neither granulomas nor neoplastic cells. Cervical biopsy revealed neoplastic cells of thyroid origin. Laboratory tests were normal. Bronchoalveolar lavage showed a normal CD4/CD8 T-cell ratio. A diagnosis of cutaneous sarcoidosis was established, as well as a recurrence of the cancerous disease. The subcutaneous nodules regressed spontaneously in the absence of any treatment. DISCUSSION AND CONCLUSION: Sarcoidosis is a multisystemic disease of unknown origin. This case illustrates an uncommon occurrence of sarcoidosis, triggered by radioactive iodine therapy. Radioiodine may lead to immunological changes, especially affecting the Th1/Th2 ratio, which may promote the emergence of sarcoidosis in genetically predisposed patients. There is still much to discover to fully understand the pathogenesis of sarcoidosis. LEARNING POINTS: The immunopathogenesis of sarcoidosis is poorly understood, as well as the environmental factors involved. Radioactive iodine therapy for thyroid cancer treatment may be an environmental trigger. The immunological changes induced by radioiodine, especially with respect to the Th1/Th2 ratio, may promote occurrence of sarcoidosis in genetically predisposed patients. SMC Media Srl 2020-05-11 /pmc/articles/PMC7417045/ /pubmed/32789128 http://dx.doi.org/10.12890/2020_001621 Text en © EFIM 2020 This article is licensed under a Commons Attribution Non-Commercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/)
spellingShingle Articles
Zaher, Wael
Place, Sammy
Gombeir, Yannick
Sudden Development of Subcutaneous Nodules Shortly after Radioiodine Treatment for Thyroid Cancer Caused by Self-Limiting Sarcoidosis
title Sudden Development of Subcutaneous Nodules Shortly after Radioiodine Treatment for Thyroid Cancer Caused by Self-Limiting Sarcoidosis
title_full Sudden Development of Subcutaneous Nodules Shortly after Radioiodine Treatment for Thyroid Cancer Caused by Self-Limiting Sarcoidosis
title_fullStr Sudden Development of Subcutaneous Nodules Shortly after Radioiodine Treatment for Thyroid Cancer Caused by Self-Limiting Sarcoidosis
title_full_unstemmed Sudden Development of Subcutaneous Nodules Shortly after Radioiodine Treatment for Thyroid Cancer Caused by Self-Limiting Sarcoidosis
title_short Sudden Development of Subcutaneous Nodules Shortly after Radioiodine Treatment for Thyroid Cancer Caused by Self-Limiting Sarcoidosis
title_sort sudden development of subcutaneous nodules shortly after radioiodine treatment for thyroid cancer caused by self-limiting sarcoidosis
topic Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7417045/
https://www.ncbi.nlm.nih.gov/pubmed/32789128
http://dx.doi.org/10.12890/2020_001621
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