Teaching Case of the Month Radiation Pneumonitis

Radiation-induced lung injury is a serious complication following thoracic irradiation for the treatment of lung, breast, or hematologic malignancies. Two distinct lung injury patterns have been described: early radiation pneumonitis and late radiation fibrosis. Both syndromes commonly include dyspnea and cough. The chest radiograph invariably shows pulmonary infiltrates. The following case describes a patient with human immunodeficiency virus (HIV) and Hodgkin’s lymphoma, who developed radiation pneumonitis after mantle radiation. The case highlights features of typical radiation pneumonitis. In addition, the case demonstrates that establishing the correct diagnosis in immunosuppressed patients requires consideration of other potential infectious and noninfectious processes.