Bleomycin-induced lung injury following intralesionalsclerotherapy for vascular malformation

The objective is to describe the presentation, evolution, and treatment of a child who presented with acute lung injury secondary to intralesional sclerotherapy with bleomycin for a venous malformation. The patient was a 4-year-old boy with a venous vascular malformation in his left lower limb, treated with percutaneous sclerosis with bleomycin (0.46 mg/kg). In the immediate postoperative period, he developed acute respiratory failure. During his evolution, pulmonary injury secondary to bleomycin was suspected. He received treatment with intravenous corticosteroids, oral corticosteroids, and supportive measures. At one year of follow-up, he was clinically stable and breathing adequately, although imaging studies showed persistent parenchymal involvement. This case reports a rare but serious complication of percutaneous bleomycin treatment. It highlights the need to maintain a high index of suspicion for acute respiratory symptoms, even at low doses, to enable timely diagnosis and treatment.