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ICI-induced Granulomatous Sialadenitis is Responsive to Prednisone

Kulchar, R. J.; Ogbonnaya-Whittlesey, A.; Beach, M. E.; Khavandgar, Z.; Pelayo, E.; Kleiner, D. E.; Perez, P.; Martin, D.; Burbelo, P.; Chiorini, J. A.; Boutros, P. C.; Wilmont Ball, D.; Boudadi, K.; Cabanillasis, M.; Baer, A. N.; Warner, B. M.

2026-01-26 allergy and immunology
10.64898/2026.01.21.26344113 medRxiv
Show abstract

Immune checkpoint inhibitors (ICIs) have transformed cancer treatment but commonly cause immune-related adverse events (irAEs), whether administered as monotherapy or in combination with other oncological agents. We present the first reported case of ICI-induced granulomatous sialadenitis in a male patient in his mid-fifties with BRAF-V600E-mutated papillary thyroid carcinoma who received sequential treatment with BRAF/MEK inhibitors followed by pembrolizumab. The patient experienced acute-onset severe xerostomia and salivary hypofunction, prompting ICI cessation and salivary gland biopsy. Integrative analysis using histology, single-cell RNA sequencing, and spatial transcriptomics revealed macrophage- and T-cell-mediated epithelial damage driven by epithelial senescence and Th1-polarized inflammation. Corticosteroid therapy reduced granuloma burden and improved salivary flow rates and tissue architecture; however, extensive fibrosis persisted despite treatment. These findings underscore the critical importance of early irAE recognition and intervention to preserve glandular function and enable continuation of cancer therapy.

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