{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:10:25Z","timestamp":1760058625760,"version":"build-2065373602"},"reference-count":14,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2025,4,16]],"date-time":"2025-04-16T00:00:00Z","timestamp":1744761600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>A 56-year-old female with a history of Luminal A breast cancer, previously treated with surgery, radiotherapy, and systemic therapy, underwent palliative re-irradiation in November 2024 for painful bone metastases. Three weeks later, following the initiation of Fulvestrant, she developed a grade 3 erythematous reaction localized to the re-irradiated area. The reaction persisted with minimal improvement over two months, despite symptomatic management. No infectious or allergic etiologies were identified, and dosimetric analysis confirmed that the delivered radiation dose to the skin was insufficient to directly induce such a reaction. Notably, the erythema was most pronounced along a pre-existing surgical scar, suggesting a localized inflammatory response. Given the temporal relationship with Fulvestrant administration, we hypothesize a drug-induced recall-like phenomenon, though no previous reports have specifically linked Fulvestrant to such an event. This case underscores the need for awareness of unexpected cutaneous reactions following re-irradiation and highlights the potential role of systemic therapies in modulating local tissue responses.<\/jats:p>","DOI":"10.3390\/diagnostics15081017","type":"journal-article","created":{"date-parts":[[2025,4,16]],"date-time":"2025-04-16T08:09:17Z","timestamp":1744790957000},"page":"1017","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["An Unusual and Exaggerated Local Cutaneous Reaction Following Re-Irradiation and Fulvestrant Administration: A Clinical Conundrum"],"prefix":"10.3390","volume":"15","author":[{"given":"Valentina","family":"Zagardo","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, REM Radioterapia Srl, 95029 Viagrande, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dorotea","family":"Sciacca","sequence":"additional","affiliation":[{"name":"Mediterranean Institute of Oncology, 95029 Viagrande, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2305-5544","authenticated-orcid":false,"given":"Gianluca","family":"Ferini","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, REM Radioterapia Srl, 95029 Viagrande, Italy"},{"name":"Department of Medicine and Surgery, University Kore of Enna, 94100 Enna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1515\/oncologie-2024-0693","article-title":"Half-body irradiation with dose escalation in the era of advanced systemic therapies: Unveiling new therapeutic opportunities","volume":"27","author":"Zagardo","year":"2025","journal-title":"Oncologie"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Grassi, F., Granata, V., Fusco, R., Muzio, F.D., Cutolo, C., Gabelloni, M., Borgheresi, A., Danti, G., Picone, C., and Giovagnoni, A. (2023). Radiation Recall Pneumonitis: The Open Challenge in Differential Diagnosis of Pneumonia Induced by Oncological Treatments. J. Clin. Med., 12.","DOI":"10.3390\/jcm12041442"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1053\/j.seminoncol.2022.04.001","article-title":"Radiation recall dermatitis: A review of the literature","volume":"49","author":"Bhangoo","year":"2022","journal-title":"Semin. Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1227","DOI":"10.1634\/theoncologist.2009-0090","article-title":"Radiation recall with anticancer agents","volume":"15","author":"Burris","year":"2010","journal-title":"Oncologist"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1440","DOI":"10.1111\/1346-8138.13427","article-title":"Levetiracetam-induced radiation recall dermatitis in a patient undergoing stereotactic radiotherapy","volume":"43","author":"Sindoni","year":"2016","journal-title":"J. Dermatol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1016\/j.abd.2021.08.017","article-title":"Radiation recall dermatitis induced by ibuprofen","volume":"98","author":"Zhang","year":"2023","journal-title":"An. Bras. Dermatol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e95","DOI":"10.1016\/j.clbc.2013.12.011","article-title":"Radiation recall reaction with letrozole therapy in breast cancer","volume":"14","author":"Foster","year":"2014","journal-title":"Clin. Breast Cancer"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1111\/1346-8138.13238","article-title":"Exemestane-induced radiation recall dermatitis and morbilliform rash","volume":"43","author":"Marchand","year":"2016","journal-title":"J. Dermatol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"100939","DOI":"10.1016\/j.tranon.2020.100939","article-title":"Enhanced toxicity with CDK 4\/6 inhibitors and palliative radiotherapy: Non-consecutive case series and review of the literature","volume":"14","author":"David","year":"2021","journal-title":"Transl. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Gagliano, A., Prestifilippo, A., Cantale, O., Ferini, G., Fisichella, G., Fontana, P., Sciacca, D., and Giuffrida, D. (2021). Role of the Combination of Cyclin-Dependent Kinase Inhibitors (CDKI) and Radiotherapy (RT) in the Treatment of Metastatic Breast Cancer (MBC): Advantages and Risks in Clinical Practice. Front. Oncol., 11.","DOI":"10.3389\/fonc.2021.643155"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1016\/j.medcli.2023.06.031","article-title":"Acute generalized exanthematous pustulosis induced by exemestane during adjuvant radiotherapy for breast cancer","volume":"161","author":"Ferini","year":"2023","journal-title":"Med. Clin."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"469","DOI":"10.5301\/tj.5000376","article-title":"Adjuvant aromatase inhibitor therapy in early breast cancer: What factors lead patients to discontinue treatment?","volume":"101","author":"Moscetti","year":"2015","journal-title":"Tumori"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1177\/10781552211027348","article-title":"Spine eburnation in a metastatic lung cancer patient treated with immunotherapy and radiotherapy. The first case report of bystander effect on bone","volume":"28","author":"Parisi","year":"2022","journal-title":"J. Oncol. Pharm. Pract."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e165","DOI":"10.1111\/ijd.14248","article-title":"Radiotherapy-induced Pemphigus Foliaceous: A rare adverse effect of breast cancer therapy","volume":"57","author":"Criado","year":"2018","journal-title":"Int. J. Dermatol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/8\/1017\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:15:42Z","timestamp":1760030142000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/8\/1017"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,16]]},"references-count":14,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2025,4]]}},"alternative-id":["diagnostics15081017"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15081017","relation":{},"ISSN":["2075-4418"],"issn-type":[{"type":"electronic","value":"2075-4418"}],"subject":[],"published":{"date-parts":[[2025,4,16]]}}}