A Case of Suspected Radiation Recall Pneumonitis After a COVID-19 Infection

Kurosaki, Hiromasa; Utsumi, Nobuko; Miura, K.

doi:10.7759/cureus.13688

Cited by 7 publications

(9 citation statements)

References 13 publications

(15 reference statements)

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“… 18 Moreover, Huges et al reported a case of vaccination-induced RRP diagnosed via an FDG-PET CT scan four days after receiving the second dose of the mRNA COVID-19 vaccine in a patient with lung adenocarcinoma who had undergone radiotherapy followed by chemotherapy and pembrolizumab eighteen months earlier. 35 A suspected case of RRP has also been reported by Kuroaski et al 20 Certain authors have described a suspected case of a 78-year-old woman who received definitive radiation therapy for small cell lung cancer three and a half years before the COVID-19 pandemic and developed a rapid decline in her respiratory status. She died but an autopsy was not performed.…”

Section: Discussionmentioning

confidence: 77%

Radiation Recall Pneumonitis COVID-19 Infection Induced After Adjuvant Breast Cancer Radiotherapy. A Known Phenomenon in an Unknown Pandemic Disease: A Case Report

Lazzari¹,

Giua²,

Verdolino³

et al. 2022

CMAR

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The COVID-19 pandemic has opened several new disease scenarios, yielding novel syndromes that have never been seen before and resurrecting old inflammatory phenomena that are no longer recorded, such as radiation recall (RR) syndromes. Radiation recall syndrome is a limited field inflammatory reaction that occurs in a volume that was irradiated several months or years previously before being induced by a triggering factor. The most frequently reported phenomena are skin reactions; however, other organs could be involved, such as the lungs in radiation recall pneumonitis (RRP). It is a well-described inflammatory reaction that occurs within a pulmonary volume that was irradiated several months or years previously via radiotherapy (RT), triggered by factors such as drugs, including chemotherapy agents, immunotherapy, or vaccination. Indeed, during the COVID-19 pandemic, RRP following anti-COVID-19 vaccination or SARS-CoV2 infection was recently reported. ACE receptor-rich tissues such as lung or skin tissues were mainly involved. Herein, we present a case of RRP triggered by COVID-19 pulmonary infection in a woman who previously underwent adjuvant breast cancer radiotherapy. Although symptoms were typical, pulmonary CT findings depicted a unique distribution of ground-glass opacities (GGOs) throughout the previous radiation portals and mirror-like the radiation fields. Anamnesis and radiation plan evaluation were crucial in the diagnosis of RRP.

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Section: Discussionmentioning

confidence: 77%

Radiation Recall Pneumonitis COVID-19 Infection Induced After Adjuvant Breast Cancer Radiotherapy. A Known Phenomenon in an Unknown Pandemic Disease: A Case Report

Lazzari¹,

Giua²,

Verdolino³

et al. 2022

CMAR

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show abstract

“…A suspected case of RRP has been shown by Kuroaski et al [20]. Authors described a suspected case of a 78-year-old woman who had received de nitive radiation therapy for small cell lung cancer three and a half years before the Covid-19 infection, developing a rapid decline in respiratory status.…”

Section: Discussionmentioning

confidence: 98%

“…Among drugs, chemotherapy, antibiotics, antimetabolites, vaccines have been involved in this process [22]. Interestingly, in this pandemic time, this phenomenon has been reported after a antiCovid-19 vaccine administration and few cases have been described due to Covid-19 infection [18,19,20]. Even if skin is reported as the most involved site, RR has been detected in other organs such as lung, oesophagus, small intestine muscle, central nervous system, and head and neck, depending on variations in tissue tolerance and local repairing mechanism.…”

Section: Discussionmentioning

confidence: 99%

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Radiation Recall Pneumonitis Covid-19 Infection Induced After Adjuvant Breast Cancer Radiotherapy. A Known Phenomenon in a Unknown Pandemic Disease. A Case Report

Lazzari

Giua

Verdolino

et al. 2022

Preprint

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BACKGROUND Covid-19 pandemic has opened several new disease scenarios yielding novel syndromes which have never been seen before or resurrecting old inflammatory phenomenon no longer recorded, like radiation recall (RR) syndromes. Radiation recall syndrome is a limited field inflammatory reaction occurring in a previous irradiated volume several months or year before induced by a triggering factor. The most reported phenomena are skin reactions, although other organs could be involved, like the lung as in radiation recall pneumonitis (RRP). It is a well described inflammatory reaction, occurring within a previous irradiated pulmonary volume several months or years later radiotherapy (RT), triggered by factors like drugs, chemotherapy agents, immunotherapy or vaccination. Indeed in the Covid -19 pandemic, RRP following anti-Covid 19 vaccination administration or SARS-CoV2 virus have been just recorded. Herein, we describe a RRP triggered by COVID-19 pulmonary infection, in a woman previously treated with adjuvant breast cancer radiotherapy. CASE PRESENTATION A 65-year-old woman was diagnosed with invasive stage III A (pT2 pN2 M0) G2, Luminal B ductal carcinoma of the right breast, in 2016. After breast conserving surgery and adjuvant chemotherapy, postoperative radiotherapy was applied on the supraclavicular area and the remaining breast.In March 2020, she complained of fever, mild dyspnoea and cough. The real-time polymerase chain reaction on nasopharyngeal swab was positive for SARS-CoV2. The chest computed tomography (CT) scan showed radiologic features in the right lung, miming the previous radiation treatment fields. She was admitted to a Covid Unit and treated per protocol. Chest CT scan 3 months later showed a complete resolution, with a consolidated pulmonary fibrosis.CONCLUSIONRadiation recall pneumonitis is an inflammatory reaction occurring within a previous irradiation of lung volume induced by triggering factors (drugs, ultraviolet light, viruses). The precise underlying mechanism has not been defined yet. A fascinating hypothesis could be that a previous radiation due to a lung repaired damage, might induce an inflammatory response that can leave a kind of “damage cell memory” and can be triggered after many years by a strong immune activation, such as occurs in COVID19 pneumonia.

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“…The SARS-CoV-2 virus itself may induce similar effects: Kurosaki et al, for instance, have reported an RRP pneumonitis coinciding with COVID-19 infection, 3.5 years after initial RT. 5 …”

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confidence: 99%