Abstract
A 53-year-old man with alcoholic liver cirrhosis underwent left lower lobectomy for primary lung cancer, well differentiated adenocarcinoma, pT1N2MO-IIIA. He received postoperative radiation therapy of a total dose of 50 Gy in 25 fractions to the bilateral hilar, mediastinal and supuraclavicular regions. A week after the completion of radiation therapy, he developed radiation pneumonitis, and prednisolone, at a dose of 30mg/day, was initiated. While tapering prednisolone, the pneumonitis was exacerbated. Although the patient responded immediately to methylpredonisolone pulse therapy, the condition exacerbated again when maintenance therapy of prednisolone was started after pulse therapy. Subsequently, the patient developed acute respiratory insufficiency. Adding methylpredonisolone pulse therapy improved the pneumonitis, and prednisolone was tapered gradually from 60mg/day and the withdrawal of glucocorticoids was successful. At the second exacerbation, Cytomegalovirus and Candida antigens were seropositive. In treating radiation pneumonitis with glucocorticoids, the possibility of steroid-withdrawal radiation pneumonitis and secondary infection should be considered.
