case_images: PMC10961452_01
case_images: Clinical findings (pretreatment). (A) One month after second dose of COVID-19 vaccine (Sep. 2021). Following the second vaccination, the dark brown macule on the left anterior thoracic region, which had been present for 20 years, partially faded. (B) Seven months after the third dose of COVID-19 vaccine (Oct. 2022). The left axillary lymph node showed swelling one week after the third vaccination on the left arm. The swelling increased rapidly over several months. The dark brown macule on the left anterior chest spontaneously resolved. Edema was present in the trunk and extremities.
case_images: fonc-14-1366532-g001.jpg
case_images: PMC10961452_01_fonc-14-1366532-g001.jpg
case_images: f1
case_images: However, the swelling increased rapidly over a few months, prompting him to visit our hospital (Figure 1).
case_images: PET findings. (A) Before the start of the treatment. Accumulation was observed in the axillary lymph nodes (SUV max 13.2), but no metastasis to the other organs or accumulation in the primary tumor was observed (left thoracic macule). (B) Six months after encorafenib/binimetinib therapy. No accumulation was found at any site. Positron emission tomography, PET.
case_images: fonc-14-1366532-g002.jpg
case_images: PMC10961452_01_fonc-14-1366532-g002.jpg
case_images: f2
case_images: Positron emission tomography (PET) demonstrated axillary lymph node accumulations (SUV max 13.2) with no metastasis to any other organ or accumulation in the primary tumor (the brown macule) (Figure 2A). At month 4 after the start of the BRAFi/MEKi therapy, the patient achieved complete remission (CR), and at month 6, no PET accumulation was found at any site (Figure 2B).
case_images: Clinical progress. (A) Before the start of nivo plus ipi therapy. The axillary mass increased in size to 17x18cm; (B) After 4 courses of nivo plus ipi. The axillary tumor shrank to 13x11cm. (C) After 1 month of encorafenib/binimetinib. The axillary mass shrank markedly to 6 x 8 cm.; (D) After 4 months of encorafenib/binimetinib. The axillary mass was no longer palpable. Nivo, nivolumab; ipi, ipilimumab.
case_images: fonc-14-1366532-g003.jpg
case_images: PMC10961452_01_fonc-14-1366532-g003.jpg
case_images: f3
case_images: The tumor shrank markedly, and the heart failure improved after one month of this treatment (Figures 3, 4).
case_images: Clinical course. Change in serum LDH and NTproBNP during ICI and BRAFi/MEKi therapy. Serum LDH was elevated before the start of ICI therapy but normalized after two courses. NTproBNP initially decreased after the start of ICI therapy but began increasing after four courses, prompting a switch to BRAFi/MEKi therapy. The NTproBNP value then decreased along with shrinkage of the axillary mass and normalized within two months.
case_images: fonc-14-1366532-g004.jpg
case_images: PMC10961452_01_fonc-14-1366532-g004.jpg
case_images: f4
case_images: The tumor shrank markedly, and the heart failure improved after one month of this treatment (Figures 3, 4).