title: Radiation recall dermatitis, panniculitis, and myositis following cyclophosphamide therapy: histopathologic findings of a patient affected by multiple myeloma.
abstract: Radiation recall dermatitis is one of the skin sequelae that may affect oncology patients. It occurs in a previously irradiated field, when subsequent chemotherapy is given. The eruption may be elicited by chemotherapy, even several months after radiotherapy. Its mechanism is poorly understood, and the histopathologic findings have received, to date, only sketchy descriptions. A 55-year-old male affected by multiple myeloma received radiation therapy both on his left coxofemoral area, and lumbar region (D11-L1). After cyclophosphamide administration, he developed 2 well defined square-shaped, infiltrated erythematoviolaceous plaques in the prior irradiated fields. Histopathologic findings revealed a diffusely fibrosclerosing process, involving deep dermis, hypodermis, as well as the underlying muscle, while sparing the epidermis and superficial-mid dermis. Histopathology was indistinguishable from deep radio-dermatitis, panniculitis, and myositis. This is the first case providing clear evidence of the causative role of cyclophosphamide in inducing a cutaneous and subcutaneous radiation recall reaction.
authors.affiliation: Department of Dermatology, University of Pavia, Policlinico S. Matteo-IRCCS, Pavia, Italy. g.borroni@smatteo.pv.it
authors.forename: Giovanni
authors.initials: G
authors.lastname: Borroni
authors.forename: Camilla
authors.initials: C
authors.lastname: Vassallo
authors.forename: Valeria
authors.initials: V
authors.lastname: Brazzelli
authors.forename: Sara
authors.initials: S
authors.lastname: Martinoli
authors.forename: Marco
authors.initials: M
authors.lastname: Ardigò
authors.forename: Paolo Emilio
authors.initials: PE
authors.lastname: Alessandrino
authors.forename: Riccardo Giovanni
authors.initials: RG
authors.lastname: Borroni
authors.forename: Pietro
authors.initials: P
authors.lastname: Franchini
mesh_terms: D018906:Antineoplastic Agents, Alkylating / Q000009:adverse effects*; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000473:pathology / Q000628:therapy*; D009220:Myositis / Q000209:etiology* / Q000473:pathology; D015434:Panniculitis / Q000209:etiology* / Q000473:pathology; D011855:Radiodermatitis / Q000209:etiology* / Q000473:pathology; D011878:Radiotherapy
chemical_list: D018906:Antineoplastic Agents, Alkylating; D003520:Cyclophosphamide