Chest

Chest

Volume 98, Issue 2, August 1990, Pages 497-499
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Life-Threatening Bleomycin Pulmonary Toxicity with Ultimate Reversibility

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A 60-year-old man with advanced seminoma was treated with four cycles of a cisplatin, etoposide and bleomycin. He then developed severe pulmonary toxicity with diffuse infiltrates as evidenced on a chest x-ray film. The room air PaO2 value was 32 mm Hg. The patient was treated with steroids and oxygen supplementation, including a high FlO, for several days, and survived and eventually experienced marked improvement in his pulmonary status. Aggressive management of severe bleomycin-induced pneumonitis appears justified.

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CASE REPORT

A 60-year-old white man with a distant smoking history and advanced seminoma was treated with four cycles of a combination of bleomycin, etoposide and cisplatin, with bleomycin given intramuscularly, 15 units weekly to a cumulative dose of 240 units. At the completion of his chemotherapy, without evidence of active seminoma, the patient complained of new dyspnea on exertion. Pulmonary function tests showed an FEV1 of 2.4 L (68 percent predicted), an FVC of 3.1 L (70 percent predicted), and a

DISCUSSION

The bleomycins are a mixture of antibiotic glycoproteins which cleave DNA via an unstable oxygenated iron-drug complex.3 The same reactive oxygen intermediates which mediate bleomycin’s antitumor activity are believed responsible for its toxicity. It has been said that patients previously treated with bleomycin may be more susceptible to lung damage, if later exposed to high FIO2 levels.4 This statement was based on a retrospective experience with five patients, previously treated with

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Copyright © 1990 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.