Vol 26, No 3 (2021)
Case report
Published online: 2021-03-26

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Radiodermatitis as a consequence of radiation recall induced by acyclovir: case report

Marcos Tumitan Zorzan1, Renata de Mello Pereira1, Lucas Farina Lima1, Tatiana Veri de Arruda Mattos2, Rafael Sá13
Rep Pract Oncol Radiother 2021;26(3):475-480.

Abstract

BACKGROUND: Radiation recall dermatitis (RRD) is an inflammatory reaction in an area of the skin previously irradiated for cancer treatment. The reaction usually occurs following the administration of a cytotoxic drug. Manifestations range from mild to severe, resulting in tissue necrosis. It is treated with removal of the probable causative agent, daily dressings and surgical debridement of the necrotic area.

CASE PRESENTATION: A 54-year-old woman had a previous diagnosis of intraductal carcinoma in situ, and had been submitted to lumpectomy and adjuvant radiotherapy and hormonal therapy. One year after surgery, sores suggestive of herpes zoster infection developed, and treatment with acyclovir was started. At the same time, there was the onset of pain and fever. In the skin area previously irradiated, there was breast hardening, skin infiltration and serosanguinolent discharge. An incisional biopsy was performed to rule out radioinduced sarcoma. The patient was treated with surgical debridement.

CONCLUSIONS: This case report describes acyclovir as a possible trigger of RRD, a rare condition that could have been mistaken for an eruption with other causes. In this case, the dermatitis reaction was confined to the previously irradiated area of the skin, which suggested radiation recall. A better understanding of the condition’s mechanism and about the possible joint effects of drugs and radiotherapy on the skin is necessary.

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References

  1. Carrasco L, Pastor MA, Izquierdo MJ, et al. Drug eruption secondary to aciclovir with recall phenomenon in a dermatome previously affected by herpes zoster. Clin Exp Dermatol. 2002; 27(2): 132–134.
  2. Azria D, Magné N, Zouhair A, et al. Radiation recall: a well recognized but neglected phenomenon. Cancer Treat Rev. 2005; 31(7): 555–570.
  3. Hong X, Wang X, Wang Z. A rare case report of acyclovir-induced immune thrombocytopenia with tongue hematomas as the first sign, and a literature review. BMC Pharmacol Toxicol. 2017; 18(1): 12.
  4. Simon A, Robb K. Cancer: Breast. Cambridge Handbook of Psychology, Health and Medicine. 2nd ed. Cambridge University Press, Cambridge 2014: 577–580.
  5. Sharma GN, Dave R, Sanadya J, et al. Various types and management of breast cancer: an overview. J Adv Pharm Technol Res. 2010; 1(2): 109–126.
  6. Boström A, Sjölin-Forsberg G, Wilking N, et al. Radiation recall — another call with tamoxifen. Acta Oncol. 1999; 38(7): 955–959.
  7. Camidge R, Price A. Characterizing the phenomenon of radiation recall dermatitis. Radiother Oncol. 2001; 59(3): 237–245.
  8. Hellman S, Botnick L. Stem cell depletion: An explanation of the late effects of cytotoxins. Int J Radiat Oncol Biol Phys. 1977; 2(1–2): 181–184.
  9. Seymour CB, Mothersill C, Alper T. High yields of lethal mutations in somatic mammalian cells that survive ionizing radiation. Int J Radiat Biol Relat Stud Phys Chem Med. 1986; 50(1): 167–179.
  10. Wright EG. Radiation-induced genomic instability in haemopoietic cells. Int J Radiat Biol. 1998; 74(6): 681–687.
  11. Abadir R, Liebmann J. Radiation reaction recall following simvastatin therapy: a new observation. Clin Oncol (R Coll Radiol). 1995; 7(5): 325–326.
  12. Wintroub B, Stern R. Cutaneous drug reactions: Pathogenesis and clinical classification. J Am Acad Dermatol. 1985; 13(2): 167–179.
  13. Fisher B, Costantino J, Redmond C, et al. Lumpectomy compared with lumpectomy and radiation therapy for the treatment of intraductal breast cancer. N Engl J Med. 1993; 328(22): 1581–1586.
  14. Fisher B, Dignam J, Wolmark N, et al. Lumpectomy and radiation therapy for the treatment of intraductal breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-17. J Clin Oncol. 1998; 16(2): 441–452.
  15. Fisher B, Land S, Mamounas E, et al. Prevention of invasive breast cancer in women with ductal carcinoma in situ: an update of the National Surgical Adjuvant Breast and Bowel Project experience. Semin Oncol. 2001; 28(4): 400–418.
  16. Patterson J, Furr B, Wakeling A, et al. The biology and physiology of ‘Nolvadex’ (tamoxifen) in the treatment of breast cancer. Br Cancer Res Treat. 1982; 2(4): 363–374.
  17. Rhee J, Kim GE, Lee CH, et al. Radiation recall dermatitis induced by tamoxifen during adjuvant breast cancer treatment. Radiat Oncol J. 2014; 32(4): 262–265.
  18. Mehta K, Kaubisch A, Tang J, et al. Radiation Recall Dermatitis in Patients Treated with Sorafenib. Case Rep Oncol Med. 2018; 2018: 2171062.
  19. Phillips T, Fu K. Quantification of combined radiation therapy and chemotherapy effects on critical normal tissues. Cancer. 1976; 37(S2): 1186–1200, doi: 10.1002/1097-0142(197602)37:2+<1186::aid-cncr2820370830>3.0.co;2-v.
  20. Oanţă A, Irimie M. Radiation Recall Dermatitis induced by Tamoxifen. Med Sci. 2012; 5(54): 113–116.



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