"Recall" pneumonitis: Adriamycin potentiation of radiation pneumonitis in two children

The radiographic findings in two children with acute "recall" pneumonitis, associated with administration of Adriamycin (doxorubicin hydrochloride) and actinomycin D at variable intervals after local radiation therapy, were presented to emphasize the unique radiographic appearance and clinical course. A 10-year-old girl underwent radiation therapy 9 weeks after completing an initial cycle of chemotherapy. Within hours of the resumption of chemotherapy, she was in clinical respiratory distress. Chest radiography showed a well-defined area of alveolar consolidation in the periphery of the right lung corresponding to the area of radiation. Shortness of breath and right chest rales developed in a 15-year-old boy within 12 hours of the resumption of chemotherapy 6 weeks after radiation therapy was completed. Chest radiography showed an alveolar infiltrate extending from the apex to the base of the right lung corresponding to the area of radiation. Symptoms may be confused with an infectious pathogenesis; thus, knowledge of the history of radiation therapy and the radiation port is important in initiating treatment with steroids rather than antibiotics.