Radiation recall pneumonitis induced by nivolumab in a patient with renal cell carcinoma

Abstract

Introduction: A radiation recall reaction in previously irradiated lungs is known as radiation recall pneumonitis. We encountered a rare case of radiation recall pneumonitis induced by nivolumab 9 months after palliative radiotherapy to the ribs.

Case presentation: The patient was a 69-year-old woman with renal cell carcinoma. She had received various drugs and palliative irradiation, which was followed by nivolumab treatment, for renal cell carcinoma. Three days after the initial nivolumab administration, she presented with respiratory symptoms. On the basis of chest computed tomography findings, she was diagnosed with nivolumab-induced radiation recall pneumonitis and treated with prednisolone (1 mg/kg). The condition resolved rapidly, and chest computed tomography 4 months after nivolumab cessation revealed interval resolution of the lung consolidation and persistent tumor shrinkage.

Conclusion: Physicians should consider the risk of radiation recall pneumonitis during treatment with immune checkpoint inhibitors in patients who have received previous thoracic radiotherapy.

Keywords: interstitial; nivolumab; pneumonitis; prednisolone; radiation recall reaction; renal cell carcinoma.

Figure 1

Radiation field and representative images obtained before nivolumab treatment and at the time of nivolumab‐induced RRP in a 69‐year‐old woman with RCC.

Figure 2

Chest CT images obtained at the time of nivolumab‐induced RRP and 4 months after the cessation of nivolumab in a 69‐year‐old woman with RCC. The image obtained at 4 months after nivolumab cessation shows interval resolution of consolidation in the right lung, along with persistent tumor shrinkage.