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Case Reports
. 2021 Apr 5;13(4):e14303.
doi: 10.7759/cureus.14303.

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

Cole R Steber  1 , Janardhana Ponnatapura  2 , Ryan T Hughes  1 , Michael K Farris  1
Affiliations
Case Reports

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

Cole R Steber et al. Cureus. .

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.

Keywords: covid-19; covid-19 vaccine; immunotherapy; non-small cell lung carcinoma (nsclc); nsclc; oligometastatic; radiation recall pneumonitis.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Radiation therapy treatment volumes
Coronal (A) and axial (B) representative slices from the original radiation therapy plan delivering 45 Gy in 15 fractions
Figure 2
Figure 2. Pre- and post-irradiation imaging
Axial section CT chest lung window (A) and axial section fused FDG PET/CT image (B) show lung mass in the upper lobe of the right lung with hypermetabolic uptake of FDG (red arrow) suggesting lung cancer. Axial section of follow-up CT chest (C) after five months of radiation therapy shows early post-radiation fibrosis surrounding the treated mass (black arrows). Follow-up CT chest (D) on March 18, 2021, at eight months after the completion of radiation therapy and after the administration of the second COVID-19 vaccine. The image shows extensive consolidation with surrounding ground-glass opacities and bronchiectasis within the prior radiation therapy portal suggestive of “Radiation Recall” type of pneumonitis (corresponding coronal image of Figure 2D within Figure 3) CT: computed tomography; PET: positron emission tomography; FDG: fluorodeoxyglucose; COVID-19: coronavirus disease 2019
Figure 3
Figure 3. Timeline of events
The patient was treated with radiation therapy and then resumed maintenance chemoimmunotherapy. Prior to the administering of the COVID-19 vaccine, there was evolving radiation fibrosis but no evidence of pneumonitis. Clinical symptoms of radiation pneumonitis began shortly after the first administration of the COVID-19 vaccine. CT imaging performed after the second dose of the COVID-19 vaccine revealed significant findings consistent with pneumonitis within the region of the previously irradiated lung COVID-19: coronavirus disease 2019
See this image and copyright information in PMC

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