Air leak: An unusual manifestation of organizing pneumonia secondary to bleomycin

Namitha, R; Nimisha, KP; Yusuf, Nasser; Rauf, CP

doi:10.4103/0970-2113.201306

Cited by 4 publications

(4 citation statements)

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“…Nine were treated with steroids and five with antibiotics. Three patients completely recovered in 1-7 months, seven died after a few days of respiratory distress, and two died from septic shock after 7 and 30 days [1][2][3][4][5][6][7][8][9][10] . DISCUSSION After the diagnosis was made, we stopped bleomycin treatment and started systemic corticosteroid therapy (1 mg/kg of body weight).…”

Section: Methods and Proceduresmentioning

confidence: 99%

Spontaneous Pneumomediastinum and Bilateral Pneumothoraces in a Patient with Bleomycin-Induced Pneumonitis

Barras

Uhlmann

2017

European Journal of Case Reports in Internal Medicine

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Bleomycin lung toxicity is well established and can manifest as bleomycin-induced pneumonitis, but pneumomediastinum and pneumothorax are very rare complications. We report the case of a 73-year-old woman, recently treated with bleomycin for Hodgkin's disease, who was admitted for bleomycin-induced pneumonitis. Two weeks later she had a pneumomediastinum with extensive subcutaneous emphysema and small bilateral pneumothoraces. Three months after that she was readmitted for dyspnoea. The CT scan showed complete regression of the pneumomediastinum but extensive bilateral ground-glass infiltrates. The patient died from respiratory failure 2 weeks later. LEARNING POINTS • Respiratory investigation before initiation of bleomycin treatment and then close follow-up during treatment of any abnormalitiesfound is mandatory, as bleomycin -induced toxicity can lead to fibrosis and secondary pneumothorax /pneumomediastinum with high morbidity/mortality. • Bleomycin-induce pneumonitis (BIP) is managed with bleomycin discontinuation (Grade 1A) and system corticosteroid (Grade 1B).• Supplemental oxygen is discouraged for BIP, but indicated for conservative management of pneumothoraces, so this case was managed with limited oxygen supplementation (aiming for oxygen saturation of 92-94%).KEYWORDS Bleomycin-induced pneumonitis, pneumomediastinum, pneumothorax CASE DESCRIPTION A 73-year-old woman who had never smoked and had been recently diagnosed with Hodgkin's lymphoma stage IIIB, was treated with two cycles of ABVD (adriamycin, bleomycin, vinblastine and dacarbazine) with a total dose of bleomycin of 200×10 3 units for 57 kg. The PET-CT scan after two cycles showed complete radiological and metabolic remission. However, a few days before the third cycle of chemotherapy, the patient developed rapidly progressive dyspnoea and a dry cough limiting her physical activity, together with mild hypoxaemia and bilateral lung crackles. A CT scan of the chest showed airspace consolidation, linear opacities, septal thickening especially at the bases, and traction bronchiectasis (Fig. 1). We diagnosed bleomycin-induced pneumonitis (BIP) because of the temporal relationship between the lung fibrosis and the treatment, and because of the absence of a differential diagnosis. We therefore stopped bleomycin and started systemic

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Section: Methods and Proceduresmentioning

confidence: 99%

Spontaneous Pneumomediastinum and Bilateral Pneumothoraces in a Patient with Bleomycin-Induced Pneumonitis

Barras

Uhlmann

2017

European Journal of Case Reports in Internal Medicine

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“…Air leak syndrome (ALS) consists of a pneumothorax, subcutaneous emphysema and pneumomediastinum and is a potential complication of multiple lung diseases. It is, however, very rare in OP, only described in case reports [2,3,[5][6][7][8]. There have been only two previous case reports where bleomycin-induced OP has caused ALS [3,5].…”

Section: Commentsmentioning

confidence: 99%

“…It is, however, very rare in OP, only described in case reports [2,3,[5][6][7][8]. There have been only two previous case reports where bleomycin-induced OP has caused ALS [3,5]. The first sign of ALS was the appearance of pneumatoceles, predominantly in the areas with most disease activity.…”

Section: Commentsmentioning

confidence: 99%

“…Bleomycin is a common cause for drug-induced pulmonary toxicity, sometimes presenting as organizing pneumonia (OP) [1]. A rare complication of OP is pneumatocele formation with spontaneous pneumothorax and pneumomediastinum, the socalled 'air-leak syndrome' (ALS) [2,3]. We present the evolution in time using chest CT scans of a patient with bleomycin-induced OP complicated by ALS, as well as histopathological correlation.…”

Section: Introductionmentioning

confidence: 99%

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Air-Leak Syndrome with Spontaneous Tension Pneumothorax and Pneumomediastinum Caused by Bleomycin-Induced Organizing Pneumonia

Vanmarcke

Steelandt

Vliegen

2022

Journal of the Belgian Society of Radiology

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Teaching Point: The appearance of pneumatoceles in a patient with organizing pneumonia is an early sign of leak syndrome and is a significant finding as its rupture can lead to a life-threatening tension pneumothorax.Air leak syndrome (ALS), consisting of pneumothorax, subcutaneous emphysema and pneumomediastinum, is a rare complication of organizing pneumonia (OP). We report a case of a patient with bleomycin-induced OP who develops a tension pneumothorax due to a ruptured pneumatocele caused by ALS and correlate with histopathological analysis. This is the third case in the literature with these findings and the first with a tension pneumothorax.

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Bleomycin

2017

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Air leak: An unusual manifestation of organizing pneumonia secondary to bleomycin

Cited by 4 publications

References 7 publications

Spontaneous Pneumomediastinum and Bilateral Pneumothoraces in a Patient with Bleomycin-Induced Pneumonitis

Spontaneous Pneumomediastinum and Bilateral Pneumothoraces in a Patient with Bleomycin-Induced Pneumonitis

Air-Leak Syndrome with Spontaneous Tension Pneumothorax and Pneumomediastinum Caused by Bleomycin-Induced Organizing Pneumonia

Bleomycin

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