RADIATION RECALL PNEUMONITIS COVID-19 INDUCED AFTER ADJUVANT BREAST CANCER RADIOTHERAPY: A CASE REPORT

Abstract

TYPE: Late Breaking Case Report TOPIC: Chest Infections INTRODUCTION: A radiation recall pneumonitis is an inflammatory reaction within a previous radiation (RT) site. COVID-19 infection in previous irradiated lung could promote a recall pneumonitis as we report herein. CASE PRESENTATION: A 65-year-old woman was diagnosed with invasive stage III A ductal carcinoma of the right breast four years ago. After breast conserving surgery, standard adjuvant RT was provided. Four years later, in March 2020, she complained of mild dyspnea and cough. The COVID-19 swab was positive. The chest CT scan showed a straight and sharp opacity in the right lung miming the previous radiation treatment fields with several ground glass opacities in both lungs. She was admitted in a Covid Unit and treated per protocol. Chest CT scan 3 months later its resolution, a pulmonary fibrosis within the irradiated fields still was observed. DISCUSSION: A radiation recall pneumonitis is an inflammatory reaction localized within a previous irradiation site following the administration of drugs like immunotherapy. Immunity is considered to be an influencing factor, but the mechanism is still unknown. It is known that COVID-19 causes immune system reactions in the lung inducing an alveolar and interstitial damage as occurs in case of radiation induced lung injury. Probably an immune memory response of CD 4+ T cells activated by previous RT may have a role. CONCLUSIONS: We described a case in which radiation recall pneumonitis was observed after COVID-19 pneumonitis four years post adjuvant RT. There are still many uncertainties that are poorly understood about COVID-19 infection and radiation pneumonitis. DISCLOSURE: Nothing to declare. KEYWORD: pneumonitis