Severe Superior Vena Cava Syndrome in a Patient With Metastatic Melanoma Receiving Nivolumab: A Case Report

Immune checkpoint inhibitors (ICIs) such as nivolumab have revolutionized cancer therapy, including melanoma. Immune-related events happen in up to 70% of patients. Sarcoid-like reactions are rare and can mimic tumor progression. An 82-year-old man with metastatic melanoma receiving nivolumab for 5 years presented with dyspnea and neck and face swelling. A computed tomography scan of the chest showed paratracheal adenopathy compressing the superior vena cava (SVC) and pleural effusion. Biopsies revealed only benign lymphocytes. The symptoms resolved with a course of prednisone. This case highlights rare nivolumab-induced lymphoid proliferation causing SVC syndrome. New SVC syndrome symptoms should prompt evaluation to distinguish between cancer progression, infection, and drug-induced lymphadenopathy.