case_images: PMC9198841_01
case_images: PMC9198841_02
case_images: (A) Initial CT scan of chest without contrast performed 27 July 2020 showed extensive patchy ground-glass infiltrates throughout both lungs and an incidental 2.4 cm diameter nodular mass (arrow) in the right lateral lower chest wall of indeterminate significance and etiology. He underwent excision of the nodule on 23 October 2020. (B) Positron emission tomography (PET) scan performed 30 October 2020, 1 week after excision of the soft tissue nodule, showed a rounded mass that measured up to 6.7 cm with a rim of abnormal fluorodeoxyglucose (FDG) activity surrounding the mass (arrow). The enlargement was attributed in part to a hematoma that developed after the initial excision. However, a wide re-excision on 23 November 2020 showed that the melanoma had spread to the inked resection margins with positive lymph nodes containing metastatic melanoma in the subcutaneous adipose tissue and tumor nodules in the deeper subcutaneous tissue. (C) Positron emission tomography (PET) scan performed 27 August 2021 showed a hypermetabolic mass in the subcutaneous fat of the right buttocks region (arrow) that measured 4.7 x 2.2 cm. In comparison, PET scan on 21 May 2021, approximately 3 months earlier, showed no hypermetabolic masses or other areas of abnormal increased glucose metabolism. Biopsy of the mass confirmed malignant melanoma.
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case_images: PMC9198841_02_fmed-09-845558-g001.jpg
case_images: F1
case_images: IL-inhibitors anakinra (an IL-1 receptor antagonist) and tocilizumab (a monoclonal antibody directed against the IL-6 receptor) were added to control hyperinflammation. Initial CT scan of the chest on July 27 showed extensive patchy ground-glass infiltrates throughout both lungs and an incidental 2.7 x 2.4 x 2.5 cm diameter soft tissue nodule in the right lateral lower chest wall (Figure 1A). Positron emission tomography (PET) scan 1 week later (Figure 1B) showed a soft tissue mass that measured up to 6.7 cm with a rim of abnormal fluorodeoxyglucose (FDG) activity surrounding the mass. May 2021, showed a new hypermetabolic lesion in the right superior gluteal subcutaneous soft tissue that rapidly increased in size to 4.7 x 2.2 cm over the ensuing 2 months (Figure 1C). MRI scan of the brain in September 2021 showed a large enhancing mass in the right frontal lobe and additional smaller enhancing masses in other brain regions.
case_images: PMC9198841_03