Rapid Development of Clinically Symptomatic Radiation Recall Pneumonitis Immediately Following COVID-19 Vaccination

Abstract

In this report, we present the case of a 66-year-old man who received local consolidation radiotherapy to the right lung and mediastinum for oligometastatic non-small cell lung cancer (NSCLC) following partial response to upfront chemoimmunotherapy. He continued with maintenance immunotherapy and was asymptomatic for eight months after completing radiation therapy. He then developed symptoms consistent with pneumonitis within three to five days of his first administration of the coronavirus disease 2019 (COVID-19) vaccine injection. He reported that these symptoms significantly intensified within three to five days of receiving his second dose of the vaccine. The clinical time frame and radiographic evidence raised suspicion for radiation recall pneumonitis (RRP). Patients undergoing maintenance immunotherapy after prior irradiation may be at increased risk of this phenomenon that may be triggered by the administration of the COVID-19 vaccine.

Cutaneous findings following COVID‐19 vaccination: review of world literature and own experience

“… 18 Correspondingly, Steber et al . 43 observed a Moderna ® ‐induced radiation‐recall pneumonitis limited to a previously irradiated upper lung segment.…”

“…According to data obtained from large clinical trials, local injection‐site reactions following minutes to few days after COVID‐19 vaccinations include erythema (20%), oedema (15%), induration (25%), pruritus (35%) and pain (88%). 43 Hence, these cutaneous adverse events are very frequent and have been associated with prior vaccines as well. Local injection‐site reactions are harmless and largely resolve within few days.…”

“…chilblain‐like lesions, morbilliform rashes and vasculitis) SARS‐CoV‐2 vaccines appear to have also the potential to induce a broad spectrum of cutaneous adverse events. 1 , 2 , 3 , 4 , 5 In this review article, 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , …”

Radiation Recall Phenomenon Following COVID-19 Vaccination

“…Both patients had been vaccinated with the Pfizer-BioNTech mRNA vaccine and the cutaneous manifestations were reportedly observed five and six days after the second vaccination which is scheduled three weeks after the initial inoculation. Two other case reports of RRP have subsequently emerged, including a case of dermatitis with the Sinovac vaccine (inactived virus) [2] and a case of pneumonitis following the Moderna (mRNA) vaccine [3]. In the Sinovac case, the skin changes were reported five days after the initial inoculation.…”

“…Two other case reports of RRP have subsequently emerged, including a case of dermatitis with the Sinovac vaccine (inactivated virus) 2 and a case of pneumonitis after the Moderna mRNA vaccine. 3 In the Sinovac case, the skin changes were reported 5 days after the initial inoculation.…”