Images in Clinical Medicine

Radiation Recall Reaction after Antimicrobial Therapy

Song K. Kang, M.D.

N Engl J Med 2006; 354:622February 9, 2006

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Article

A woman with stage T3N0 anal carcinoma was treated with radiotherapy and concurrent chemotherapy with fluorouracil and mitomycin. The total dose of radiotherapy was 5940 cGy, with the high-dose area shaped as a rectangle measuring 8 cm by 10 cm (Panel A). The arrows indicate the borders of the radiation field. The arrowhead points to the anal marker. Three years after the completion of radiation therapy, the patient was prescribed gatifloxacin for an upper respiratory tract infection. After three days of antimicrobial therapy, severe erythema developed, with moist desquamation in the perineal–gluteal area (Panel B). The area of the reaction had a rectangular shape and correlated with the borders of the high-dose radiation field. Gatifloxacin was stopped, and the reaction resolved over a period of four days with conservative management.

Radiation recall reactions are usually associated with chemotherapeutic agents such as doxorubicin but have also been reported with antibiotic drugs. Fluoroquinolones have been associated with phototoxicity and recall reactions after ultraviolet radiation.

Song K. Kang, M.D.
Naval Medical Center San Diego, San Diego, CA 92134-1014

Citing Articles (6)

Citing Articles

1. 1

   A. Gabriella Wernicke, Alexander J. Swistel, Bhupesh Parashar, Patricia L. Myskowski. (2010) Levofloxacin-Induced Radiation Recall Dermatitis: A Case Report and a Review of the Literature. Clinical Breast Cancer 10:5, 404-406
   CrossRef

2. 2

   S Jain, J Agarwal, S Laskar, T Gupta, S Shrivastava. (2008) Radiation recall dermatitis with gatifloxacin: A review of literature. Journal of Medical Imaging and Radiation Oncology 52:2, 191-193
   CrossRef

3. 3

   T.J. FitzGerald, Maryann Bishop Jodoin, Gayle Tillman, Jesse Aronowitz, Richard Pieters, Susan Balducci, Joshua Meyer, M. Giulia Cicchetti, Sidney Kadish, Shelagh McCauley, Joanna Sawicka, Marcia Urie, Y.C. Lo, Charles Mayo, Kenneth Ulin, Linda Ding, Maureen Britton, Jiayi Huang, Edward Arous. (2008) Radiation Therapy Toxicity to the Skin. Dermatologic Clinics 26:1, 161-172
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4. 4

   R. Sacher. (2007) Recall-Reaktion – eine Ursache für rezidivierende reversible Gelenkdysfunktionen?. Manuelle Medizin 45:6, 421-422
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5. 5

   D. H. S. Tan, P. E. Bunce, W. C. Liles, W. L. Gold. (2007) Gemcitabine-Related "Pseudocellulitis": Report of 2 Cases and Review of the Literature. Clinical Infectious Diseases 45:5, e72-e76
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6. 6

   A.W.Y. Ng, F.C.S. Wong, S.Y. Tung, S.K.O.. (2007) Nimesulide — a New Trigger of Radiation Recall Reaction. Clinical Oncology 19:5, 364-365
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