Researchers have reported a new case of cutaneous sarcoidosis in a Finnish woman previously treated for Hodgkin’s lymphoma — a type of blood cancer — noting that sarcoidosis development after lymphoma may be underreported.
Sarcoidosis-related chronic inflammation leads to the formation of small abnormal lumps or nodules — called granulomas — in several organs of the body. Lungs are the most commonly affected, followed by lymph nodes, skin, and eyes.
Several studies have suggested that patients with sarcoidosis have twice the risk of developing lymphoma, a type of blood cancer. This condition has been called sarcoidosis-lymphoma syndrome. Sarcoidosis also has been reported to have occurred after cancer or cancer treatment, including cases of Hodgkin’s lymphoma patients treated with immunotherapy.
A previous review study has shown that the median delay between lymphoma and the development of sarcoidosis is of 18 months, and that skin involvement is observed in only 20.5% of cases. Less than half of these patients require treatment for sarcoidosis because of its generally mild or self-healing nature.
It also has been hypothesized that sarcoidosis can be the result of an excessive immune response against cancer cells, which may be triggered by anti-cancer therapy.
Now, researchers at Finland’s Helsinki University Central Hospital have reported a case of a 62-year-old Finnish woman who was referred to the hospital for suspicion of cutaneous sarcoidosis.
She had been diagnosed with Hodgkin’s lymphoma in July 2016, and subsequently completed anti-cancer treatment with first-line Adriamycin–Bleomycin–Vinblastine–Dacarbazine (ABVD) chemotherapy and radiotherapy in the same year.
At the beginning of 2018 — more than a year after diagnosis and treatment — she reported the presence of subcutaneous (under the skin) nodules on both thighs, with no associated inflammation or pain, and changes in two old scars.
Clinical examination revealed the presence of nodules on both sides of the thigh, alterations in both old scars, and the presence of a small red-orange bump on the right knee. An analysis of a tissue sample collected from the knee bump confirmed a cutaneous sarcoidosis diagnosis.
The patient was prescribed standard corticosteroids creams for the scars, and during follow-up the thigh nodules were almost completely resolved.
This case “acts as a reminder that sarcoidosis may occur after Hodgkin lymphoma and that modification of recent or old scars should prompt to suspect sarcoidosis,” researchers said.
They also emphasized that while sarcoidosis following lymphoma seems to be rare, it is most likely underreported, and that improvements in diagnostic and imaging techniques may increase sarcoidosis diagnoses following lymphoma treatment.
The researchers noted that the clinical similarities between sarcoidosis and lymphoma can lead to misdiagnosis and that physicians must be aware and alert of these similarities and of the possibility that they might occur sequentially.
They highlighted that symptoms such as fever, weight loss, or night sweats in sarcoidosis patients should not automatically be attributed to the disease, while sarcoidosis should be considered when in the presence of suspected lymphoma relapse, and that tissue analysis is required to confirm the diagnosis.