Correct!
2. Repeat course of corticosteroids

Our patient was restarted on steroid therapy (1 mg/kg prednisone) and has clinically improved. She has returned home and will be having repeat outside imaging.

This patient had radiographic findings that were atypical for radiation pneumonitis (significant infiltrate outside of the radiation port to the thymus, including in opposite lung). Eosinophilic pneumonia can be associated with drug therapy, exposure to toxins or can be idiopathic. It has also been reported in association with radiation therapy (2,3). When associated with radiation therapy, eosinophilic pneumonia has been seen most commonly after radiation for breast cancer. Patients demonstrate alveolar infiltrates that may develop both inside and outside of the radiation port within 12 months of radiation therapy, without another identifiable cause of eosinophilic pneumonia. Patients typically respond well to corticosteroids.

References

1. Weytjens R, Erven K, De Ruysscher D. Radiation pneumonitis: occurrence, prediction, prevention and treatment. Belg J Med Oncol. 2013;7(4):105-10.
2. Solomon J, Schwartz M. Drug-, toxin-, and radiation therapy-induced eosinophilic pneumonia. Semin Respir Crit Care Med 2006;27:192-8. [CrossRef] [PubMed]
3. Cottin V, Frognier R, Monnot H, et al. Chronic eosinophilic pneumonia after radiation therapy for breast cancer. Eur Respir J. 2004;23:9-13. [CrossRef] [PubMed]

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