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Diffuse Lung Disease: Diffuse Lung Disease |

Bleomycin-Induced Pneumonitis in a 16-Year-Old Girl With Hodgkin Lymphoma and No Risk Factors: Complete Reversibility With Steroids FREE TO VIEW

Eleftheria Haini, MD; Antonis Georgopoulos, MD; Dimitra Haini, MD; Manos Antonakis, MD; Miltos Vassiliou, MD
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Corfu General Hospital, Corfu, Greece


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(4_S):A190. doi:10.1016/j.chest.2016.02.197
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SESSION TITLE: Diffuse Lung Disease

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, April 17, 2016 at 11:45 AM - 12:45 PM

INTRODUCTION: Pneumonitis is a major side-effect induced by Bleomycin therapeutic use, known as Bleomycin induced Peumonitis (BIP). Its clinical course resembles mainly to community acquired pneumonia (CAP). Various risk factors have been associated with BIP development and they are considered as crucial for its incidence. Steroids are widely used for BIP therapy.

CASE PRESENTATION: A 16-year-old girl with Hodgkin’s Lymphoma under chemotherapy including bleomycin (accumulative dose of 90 units) was admitted with fever and dyspnea. Patient’s temperature was 39.5o C with 22 breaths/minute, SpO2 92% (FiO2 21%), heart rate 140 beats/minute, arterial pressure 110/70 mmHg and fine bibasilar crepitations. Echocardiogram was normal. Chest radiograph showed patchy consolidations in the left lung base. Blood white cells and neutrophils count were normal. C-reactive protein was 11.4 mg/dl, hematocrit 28, 2%, hemoglobin 9, 33 gr/dl, and Erythrocyte Sedimentation Rate 106 mm. Blood cultures and urinary antigen tests for Pneumococcus and Legionella were negative. The patient was treated as CAP with Moxifloxacine and Trimethoprime/Sulphamethoxazole. However, the patient’s clinical status deteriorated. Fever did not respond to the applied antibiotic therapy. Dyspnea and tachypnea worsen (breaths 40/min, SpO2 95% on FiO2 60%), and platypnea developed. On the 3rd hospitalization day, chest computerized tomography (CCT) showed bilateral diffuse ground glass opacities affecting all lung fields and paraspinal bibasilar consolidations. No findings of pulmonary embolism were observed. Based on CCT findings along with clinical deterioration under antibiotics, BIP became the first diagnostic choice. The patient was treated with Prednizolone 1 mg/Kgr body weight with immediate dramatic improvement. Seven days later the patient was discharged without any symptoms and signs. Steroids were gradually tapered. Six years later the patient is in excellent condition.

DISCUSSION: BIP has been associated with age > 40 years, cumulative bleomycin dose > 300 units, low glomerular filtration rate, advanced disease, inhalation of high oxygen concentrations, cigarette smoking and concomitant chest radiotherapy. The presented case was not associated with any predisposing factor. Early recognition of BIP and initiation of steroids helped in complete recovery of the patient.

CONCLUSIONS: BIP should be suspected in patients under bleomycin chemotherapy who develop fever, dyspnea and fine bibasilar crepitations, even if they do not fulfill any additional risk factors ctiteria. Early BIP diagnosis and initiation of steroids treatment is vital and may help in complete recovery.

Reference #1: Sleijfer S. Bleomycin-induced pneumonitis. Chest 2001;120:617-24.

Reference #2: O’Sullivan JM, Huddart RA, Norman AR, et al. Predicting the risk of bleomycin lung toxicity in patients with germ-cell tumours. Ann Oncol 2003;14:91-6

DISCLOSURE: The following authors have nothing to disclose: Eleftheria Haini, Antonis Georgopoulos, Dimitra Haini, Manos Antonakis, Miltos Vassiliou

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