{
  "abstract": "A man in his 60s with metastatic Merkel cell carcinoma was treated with avelumab. After 8 months, he achieved complete resolution of cutaneous lesions. At 13.5 months, he developed erythematous chest papules with biopsy-proven non-necrotising granulomas. Imaging revealed bilateral hilar and mediastinal lymphadenopathy, and serum calcium was elevated at 3.02 mmol/L. This is consistent with a sarcoid-like reaction to avelumab. High-dose prednisolone resolved sarcoid lesions and normalised calcium. However, avelumab rechallenge triggered recurrent hypercalcaemia and renal deterioration, raising concern for immunotherapy-related sarcoid nephritis. Avelumab was permanently discontinued after 2 years, and the sarcoid-like reaction remained inactive thereafter.",
  "authors": [
    {
      "affiliations": [
        "Internal medicine, University Hospitals Sussex NHS Foundation Trust, Brighton, UK"
      ],
      "name": "Tiffany Tuhirman"
    },
    {
      "affiliations": [
        "Dermatology, University Hospitals Sussex NHS Foundation Trust, Chichester, UK"
      ],
      "name": "James Coe"
    }
  ],
  "title": "Sarcoid-like reaction to avelumab during therapy for metastatic Merkel cell carcinoma",
  "uid": "67e4a8c9-b896-5410-84c3-9e7d029e313e"
}