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Radiation recall dermatitis exacerbation and organising pneumonia: case report A 71-year-old woman had an exacerbation of radiation recall dermatitis (RRD) during treatment with cyclophosphamide and docetaxel and developed organising pneumonia during treatment with cyclophosphamide, docetaxel and letrozole, for invasive ductal carcinoma. The woman, who was found to have grade II invasive ductal carcinoma, received adjuvant radiotherapy (RT). Three weeks after the RT completion, she received adjuvant chemotherapy with docetaxel and cyclophosphamide for 4 cycles. However, prior to the initiation of chemotherapy, her skin was intact with erythema limited to the axilla. One week post starting chemotherapy and 4 weeks after completing RT, she presented with left breast tenderness, erythema and warmth with no fevers. The woman received a trial of cephalexin for 1 week for a differential diagnosis included cellulitis versus RRD. Thereafter, she received oral prednisone 20mg daily for 7 days and silver sulfadiazine for presumed RRD. One week after initiating prednisone, she reported marked improvement in her skin appearance. Later on, she was premedicated with prednisone 20mg for cycle 2 of chemotherapy. However, she developed less severe RRD after her second cycle of chemotherapy, so prednisone was increased to 30mg, followed by a brief taper for the third and fourth chemotherapy cycles. The patient tolerated the remaining cycles of chemotherapy well and successfully completed chemotherapy. Thereafter, she started receiving letrozole 3 weeks post completion of chemotherapy [dosages and routes not stated]. During her 6 month post-radiation treatment follow-up, she reported a dry cough for 2 weeks without fever. A chest X-ray showed consolidation in the left middle lung concerning for pneumonia. For her symptoms and abnormal X-ray, she received azithromycin and benzonatate. Thereafter, she became febrile (101.5°F), and presented to the emergency department, where a CT angiogram of her chest revealed evidence of left upper and left lower-lobe infiltrates. She was then hospitalised and received unspecified IV antibiotics but showed no improvement, and developed increased shortness of breath. Bronchoscopy with bronchoalveolar lavage showed elevated lymphocytes (73%), monocytes (2%) and eosinophils (12%) on the cell count differential, and cultures revealed only normal respiratory flora. She was then initiated on prednisone 60mg daily for presumed radiation pneumonitis. Within 1 day, she reported improvement in symptoms. A chest CT completed around 1.5 months later demonstrated improvement in the consolidation, and she had returned to her baseline respiratory function. She completed prednisone tapering approximately 1 month later. However, she was admitted again 1.5 months following completing prednisone taper due to fatigue and shortness of breath. A chest CT revealed bilateral multifocal rounded consolidations and airspace disease concerning for organising pneumonia. Bronchoscopy with bronchoalveolar lavage revealed 2% l