case_images: PMC8339402_01
case_images: 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.
case_images: fmed-08-679111-g0001.jpg
case_images: PMC8339402_01_fmed-08-679111-g0001.jpg
case_images: F1
case_images: 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).
case_images: (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.
case_images: fmed-08-679111-g0002.jpg
case_images: PMC8339402_01_fmed-08-679111-g0002.jpg
case_images: F2
case_images: 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).
case_images: (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.
case_images: fmed-08-679111-g0003.jpg
case_images: PMC8339402_01_fmed-08-679111-g0003.jpg
case_images: F3
case_images: 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.
case_images: (A) Follow-up T1-weighted image and (B) contrast T1-weighted image after 5 months showed complete resolution of all previously noted bony lesions.
case_images: fmed-08-679111-g0004.jpg
case_images: PMC8339402_01_fmed-08-679111-g0004.jpg
case_images: F4
case_images: 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).