Fig. 18
69 year-old man with ulcerated right occipital scalp melanoma, 5 mm deep, mitotic rate of 4 with locoregional nodal metastasis in the right sub-occipital and cervical stations as well as biopsy proven distant metastatic disease in the liver demonstrated on 18F-FDG PET MIP (arrows, panel A). Following three cycles of combination ipilimumab and nivolumab presented to emergency department with acute kidney injury (serum creatinine rose from 0.8 mg/dL to 2.8 mg/dL) with progressive fatigue, generalized weakness and poor oral intake. 18F-FDG PET MIP (panel B) at 3 months showed resolution of all disease in the right neck and liver and development of FDG-avidity of multiple organs including diffuse parenchymal 18F-FDG uptake by both kidneys (panel C and D), diffuse FDG uptake in the pancreas (panel E and F), diffuse 18F-FDG uptake in the left lobe of the live (arrow heads, panel G and H), marked diffuse 18F-FDG uptake in the spleen (arrows, panel G and H) as well as bilateral axillary, iliac and inguinal lymphadenopathy (panel I an J) suggestive of, interstitial nephritis, pancreatitis, likely cholangitis and granulomatous disease, respectively. The patient discontinued ICIs and was treated with high dose corticosteroid and all findings resolved at 5 months follow-up with gradual improvement in serum creatinine (Panel K)