Correct!
4. Re-recommend corticosteroids
Corticosteroids are commonly used for the treatment of radiation pneumonitis (4). Prednisone is started at 1 mg/kg/day upon diagnosis and is continued for several weeks and then tapered slowly. Other agents that have been used for treatment of radiation pneumonitis include azathioprine and cyclosporin A but there is limited experience with these medications.
The patient had relief of her dyspnea and serial chest x-rays (Figure 4) and a CT scan (Figure 5) showed improvement in her lung consolidation.
Figure 4. Serial chest x-rays from 1/30/13 (A), 2/6/13 (B), 2/20/13 (C) and 5/6/13 (D).
Figure 5. Selected lung windows from a thoracic CT scan (A-G) performed on 5/6/13. Movie of selected windows from the same CT scan (lower panel).
It is unclear what role nitrofurantoin played in the patient’s overall illness. It is possible that the combination of the nitrofurantoin may have exacerbated the radiation pneumonitis although a PubMed search revealed no reports.
References