Abstract
We present a case of a 64-year-old man with a history of metastatic, stage IV, poorly differentiated lung carcinoma and chronic obstructive pulmonary disease who presented to the hospital for a new onset rash after receiving chemotherapy. The patient had previously received palliative radiation therapy and eight days after received chemotherapy with pembrolizumab, pemetrexed, and carboplatin. Physical exam demonstrated warm, tender, well-demarcated erythematous papules coalescing into plaques spanning the thoracic and lumbar spine of the mid to lower back. Biopsy of the rash revealed epidermal necrosis and apoptotic keratinocytes with a neutrophilic infiltrate and marked dermal sclerosis consistent with subacute radiation dermatitis. The patient was subsequently treated with wet wraps of triamcinolone cream, but unfortunately expired two weeks later. Radiation recall dermatitis (RRD) is a rare phenomenon manifesting as an inflammatory reaction of the skin at a site of previous irradiation after administration of pharmacologic or promoting agent. RRD occurs at least seven days after the completion of radiotherapy, as seen in our patient. This case reviews the most common chemotherapeutic agents associated with RRD and highlights that drugs less commonly associated with RRD should be considered when attempting to select a culprit for this dermatologic manifestation.