PMC8339402_01
Timeline of computed tomography images during the therapeutic course. (A) The initial images at the time of diagnosis, (B) The images after first-line chemotherapy showed reduction of right lower lobe lung cancer and mediastinal lymph node metastasis, (C) The images after 7 months of first-line chemotherapy showed lymph node recurrence (arrow), (D) The images after second-line chemotherapy showed reduction of mediastinal lymph node metastasis; PFS, progression-free survival.
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F1
Figure 1. Four months after starting the treatment, the tumour had reduced in size, but the patient developed severe back pain and a rash on both palms resembling pustulosis palmoplantaris (Figure 2A).
(A) The patient developed palmoplantar pustular skin lesions after 4 months of pembrolizumab immunotherapy, (B) Bone scan detected multiple abnormal sites of uptake at the left sternoclavicular joints and across multiple vertebrae.
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F2
Figure 1. Four months after starting the treatment, the tumour had reduced in size, but the patient developed severe back pain and a rash on both palms resembling pustulosis palmoplantaris (Figure 2A). Accordingly, the bone scan revealed abnormal uptake in multiple vertebrae and left sternoclavicular joint (Figure 2B).
(A) Spine magnetic resonance imaging showed hypointense area on T1-weighted image, (B) abnormally enhancing effect on contrast T1-weighted image in contiguous anterior thoracic vertebral corners. These multiple vertebral lesions had a characteristic semi-circular pattern (dashed line) in contiguous vertebral body segments.
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F3
T1-weighted images and contrast-enhancing effects on contrast T1-weighted images (Figure 3). These multiple vertebral lesions had a characteristic pattern of SAPHO syndrome showing a semi-circular pattern of contiguous vertebral body involvement localised at the anterior vertebral corners, unlike the usual bone metastases.
(A) Follow-up T1-weighted image and (B) contrast T1-weighted image after 5 months showed complete resolution of all previously noted bony lesions.
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F4
Five months after the discontinuation of pembrolizumab and immunosuppression therapy with prednisolone, the follow-up MRI showed complete resolution of all previously observed multiple bone lesions (Figure 4).