Severe radiation pneumonitis precipitated by withdrawal of corticosteroids: a diagnostic and therapeutic dilemma

Pulmonary injury secondary to radiation (radiation pneumonitis) is a well recognized syndrome. The occurrence and extent of damage are related, in part, to the total dose and degree of fractionation of radiation and the volume of lung irradiated. The concomitant use of various cancer chemotherapeutic agents is thought to exacerbate this radiation effect. Recently, Kaplan and Castellino, et al. described a group of patients who appeared to develop radiation pneumonitis when corticosteroids were abruptly discontinued or tapered rapidly. Our case is notable in view of the severity of the radiation pneumonitis which occurred after the abrupt cessation of corticosteroids and the confirmation of the diagnosis by lung biopsy prior to the reinstitution of corticosteroids