A case of herpes zoster masquerading as stereotactic body radiation therapy associated chest wall pain in a patient treated for primary non-small cell lung cancer

Abstract

Introduction: Lung cancer is the leading cause of cancer-related death in the United States. In patients with Stage I non-small cell lung cancer (NSCLC) deemed medically inoperable due to comorbities, stereotactic body radiation therapy (SBRT) is the standard of care. We are reporting a case of a medically inoperable patient with Stage I NSCLC who received SBRT to the lung. The patient presented herpes zoster masquerading as radiation-related chest wall pain.

Presentation: The patient was a 76-year-old Caucasian female with a 40-pack year history of tobacco who presented with a solitary pulmonary nodule on chest x-ray during a COPD exacerbation. Workup revealed squamous cell carcinoma, and the patient was determined to be medically inoperable due to poor lung function secondary to COPD.  Nine months after completion of SBRT, the patient presented with chest wall pain that evolved into herpes zoster along the T4 dermatome.

Conclusion: We are presenting a case SBRT-related herpes zoster. While chest wall pain is a common side effect of this treatment, herpes zoster has not been previously reported. Because shingles most commonly presents as a pain episode before rash eruption, it can be easily mistaken for chest wall pain alone. Shingles can be treated effectively with anti-viral medications and anti-inflammatory agents. Thus, it is important to keep this side effect in mind for patients who receive SBRT to the lung and follow-up with chest wall pain.