Radiation recall dermatitis with soft tissue necrosis following pemetrexed therapy: a case report

• Published in: Journal of medical case reports 2009-11, Vol.3 (1), p.93-93, Article 93
• Main Authors: Spirig, Christian, Omlin, Aurelius, D'Addario, Giannicola, Loske, Klaus-Dieter, Esenwein, Philipp, Geismar, Jan Henning, Ruhstaller, Thomas
• Format: Article
• Language: English
• Subjects: Case report; Case studies; Complications and side effects; Dermatitis; Diagnosis; Dosage and administration; Inflammation; Necrosis; Pemetrexed; Risk factors; Skin
• ISSN: 1752-1947; 1752-1947
• DOI: 10.1186/1752-1947-3-93

Radiation recall dermatitis is a well known but still poorly understood inflammatory reaction. It can develop in previously irradiated areas and has been shown to be triggered by a variety of different drugs, including cytostatic agents. Pemetrexed may cause radiation recall dermatitis in pre-irradiated patients. We present the case of a 49-year-old Caucasian woman with non-small cell lung cancer who was initially treated with carboplatin and paclitaxel concomitant with radiotherapy after suffering a painful plexus brachialis infiltration. Due to disease progression, a second-line treatment with pemetrexed was started. A severe soft tissue necrosis developed despite steroid treatment and plastic surgery. To the best of our knowledge, we present the first case of a patient with severe soft tissue necrosis in a pre-irradiated area after pemetrexed therapy. We believe that physicians treating patients with pemetrexed should be aware of the severe, possibly life-threatening effects that may be induced by pemetrexed after previous radiation therapy.