Track: Case Reports

Topic: Other

Abstract:

Radiation recall dermatitis (RRR) is a rare drug-induced inflammatory reaction occurring in a previously irradiated site, precipitated by drug administration. It was initially described by D'Angelo et al. in 1959 in association with Actinomycin D, followed by reports of other drug associations. Clinical manifestations of RRR include maculopapular rash, desquamation, pruritus, swelling, and ulceration. We report a case of a 40-year-old woman with invasive ductal mammary carcinoma who was treated with left breast mastectomy with left axillary lymph node dissection and keynote-522 (pembrolizumab+paclitaxel+carboplatin+adriamycin+Cytoxan) followed by radiotherapy. Two months after the cessation of radiotherapy, capecitabine was started. Two weeks later, she developed a red, burning rash on her palms and soles, compatible with hand-foot syndrome (HFS, also called palmar-plantar erythrodysesthesia), a side effect of some chemotherapy drugs that cause redness, swelling, and blistering on the palms and soles. Additionally, she developed a red, itchy rash on her left breast and lateral chest. The patient tried betamethasone and mometasone with no improvement. Capecitabine was discontinued and her hands and feet improved, but the breast erythema persisted and blistered. A punch biopsy of the breast showed vacuolar interface changes with dyskeratotic cells, subepidermal blister, and lichenoid infiltrate with eosinophils, supporting the clinical impression of RRR and prompting treatment with oral steroids. HFS is a frequently reported side effect of capecitabine therapy and there are documented cases of capecitabine-induced radiation recall phenomenon. This case illustrates the rare combination of both HFS and RRR in a breast cancer patient treated with capecitabine.

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Pauline Ong Sui, MD