Bleomycin, a Glycopeptide antibiotic, was discovered in 1966 to possess antitumor cytotoxic activity. Its potent tumoricidal properties have secured it a vital role in cancer chemotherapy. While it causes minimal myelosuppression, pulmonary toxicity is a serious and potentially life-threatening adverse effect, occurring in approximately 10% of patients (range 6-18%), with a reported mortality rate of 3-5%. The patterns of lung injury are diverse and include diffuse alveolar damage (DAD), interstitial fibrosis, nonspecific interstitial pneumonia (NSIP), organizing pneumonia (OP), and eosinophilic pneumonia. Pneumothorax and pneumomediastinum are recognized as very rare complications of Bleomycin. Herein, we present a rare case of Bleomycin-induced interstitial pneumonia complicated by spontaneous pneumomediastinum. This case highlights the importance of early recognition, accurate differential diagnosis, and prompt management of this uncommon yet potentially fatal complication.
BLEOMYCIN-INDUCED INTERSTITIAL PNEUMONITIS AND PNEUMOMEDIASTINUM: CASE STUDY
257
Views
0
Downloads
Keywords
Interstitial pneumonia, mediastinal emphysema, drug-induced lung disease, Bleomycin-induced lung disease.
Abstract
References
[1]
Umezawa H, Maeda K, Takeuchi T, Okami Y. New antibiotics, Bleomycin A and B. J Antibiot (Tokyo), 1966, 19 (5): 200-209.
Google Scholar
[2]
Balaji O, Amita D, Patil N, Thomas J. Bleomycin-induced reversible acute interstitial pneumonia. Asian J Pharm Clin Res, 2017, 10 (5): 6-8. doi: 10.22159/ajpcr.2017.v10i5.17121
Google Scholar
[3]
O’Sullivan J.M, Huddart R.A, Norman A.R, Nicholls J, Dearnaley D.P, Horwich A. Predicting the risk of Bleomycin lung toxicity in patients with germ-cell tumours. Ann Oncol Off J Eur Soc Med Oncol, 2003, 14 (1): 91-96. doi: 10.1093/annonc/mdg020
Google Scholar
[4]
Uzel I, Ozguroglu M, Uzel B et al. Delayed onset Bleomycin -induced pneumonitis. Urology, 2005, 66 (1): 195. doi: 10.1016/j.urology.2005.01.038
Google Scholar
[5]
Spagnolo P, Bonniaud P, Rossi G, Sverzellati N, Cottin V. Drug-induced interstitial lung disease. European Respiratory Journal, 2022, 60 (4): 2102776. doi: 10.1183/13993003.02776-2021
Google Scholar
[6]
Sleijfer S. Bleomycin-induced pneumonitis. Chest, 2001, 120 (2): 617-624. doi: 10.1378/chest.120.2.617
Google Scholar
[7]
Hay J, Shahzeidi S, Laurent G. Mechanisms of Bleomycin -induced lung damage. Arch Toxicol, 1991, 65 (2): 81-94. doi: 10.1007/BF02034932
Google Scholar
[8]
Lauritsen J, Kier M.G.G, Bandak M et al. Pulmonary function in patients with germ cell cancer treated with Bleomycin, Etoposide, and Cisplatin. J Clin Oncol Off J Am Soc Clin Oncol, 2016, 34 (13): 1492-1499. doi: 10.1200/JCO.2015.64.8451
Google Scholar
[9]
Grahmann P.R, Brauer M, Hüter L, Sayer H, Neumann R, Braun R.K. Respiratory failure and pulmonary fibrosis as a late side-effect after chemotherapy-induced by oxygen administration. Pneumol Stuttg Ger, 2005, 59 (11): 763-769. doi: 10.1055/s-2005-919069
Google Scholar
[10]
Bijawat K, Yumori C et al. Bleomycin-induced pneumonitis (BIP) complicated by large-volume pneumomediastinum. Am J Respir Crit Care Med, 2025, 211 (Supplement_1): A1894. doi: 10.1164/ajrccm.2025.211.
Google Scholar
[11]
Iteen A.J, Bianchi W, Sharman T. Pneumomediastinum. StatPearls. NCBI Bookshelf. Accessed September 30, 2025.
Google Scholar
[12]
Sahni S, Verma S, Grullon J, Esquire A, Patel P, Talwar A. Spontaneous pneumomediastinum: time for consensus. North Am J Med Sci, 2013, 5 (8): 460-464. doi: 10.4103/1947-2714.117296
Google Scholar