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Sarcoid like reaction is a well-known entity that occurs as a consequence to several malignancies or their therapies. Immunotherapy has gained a lot of interest in the past few years and has recently gained approval as first line therapy in multiple advanced stage malignancies. Pneumonitis has been described as complication of such therapy. Granulomatous inflammation has been only rarely reported subsequent to immunotherapy. We describe a case of granulomatous inflammation reactivation affecting the lungs in a patient previously exposed to Pembrolizumab and have evidence of a distant granulomatous infection. We discuss potential mechanisms of the inflammation and assert the importance of immunosuppression in controlling the dis-inhibited immune system.

It is no secret that the link between infection and vasculitis is well established even though the exact mechanism is still under study [1]. Infection, in addition to other factors, has been counted to trigger Vasculitis. The causal relationship has been documented only in few cases like Polyarthritis Nodosa (PNA)/Hepatitis B virus (HBV) and Cryoglobulinemia/Hepatitis C virus (HCV) cases [1]. There has also been an established link between Methicillin-Resistant-Staphylococcus aureus (MRSA) and Microscopic Polyangitis with perinuclear anti-neutrophils-cytoplasmic-antibody (P-ANCA) [2]. In addition, post MRSA infection IgA glomerulonephritis [2] is well described. We present a rare case of pulmonary-renal syndrome secondary to recurrent MRSA spondylodiscitis. The mechanism of involvement of each organ system is unique. The organs, lung and kidneys, have been affected by different pathologic processes that were induced, we think, by the chronic MRSA infection.