Bleomycin and Cyclophosphamide Toxicity Simulating Metastatic Nodules to the Lungs in Childhood Cancer

Abstract

Two pediatric oncology patients with Ewing's sarcoma and one with mixed germ cell tumor were treated with drug regimens that included bleomycin or cyclophosphamide. Despite progress to apparently complete remission, all manifested pulmonary nodules on computed tomography during or at the end of treatment. Thoracoscopic biopsy to confirm metastasis revealed instead fibrotic lesions apparently attributable to bleomycin or cyclophosphamide. After cessation of chemotherapy, the pulmonary lesions resolved and all three patients sustained their remissions. The case histories and comments on the diagnosis and management of pulmonary nodules are reviewed.

An Unusual Radiologic Pattern of Cryptogenic Organizing Pneumonia: Diffuse Pulmonary Nodules in a Leukemia Patient

“…In our patient, the question of drug-induced COP arises as bone marrow transplantation was not performed and the clinical and radiological manifestations of pulmonary lesions developed after chemotherapy. Our patient, however, was not given bleomycin, which has been associated with nodular COP mimicking pulmonary metastases (10). The association between the administration of high-dose intravenous ARA-C and lung toxicity is well recognized, and Battistini et al (11) reported the development of COP in three children with acute leukemia who received a combination of high-dose ARA-C and anthracyclines, which is similar to the regimen that was followed by our patient.…”