Diverse Presentations of Bleomycin-Induced Lung Injury: A Case Series

Drug-related toxicities are a well-known phenomenon, affecting any organ and potentially causing morbidity. Adriamycin, Bleomycin, Vinblastine, Dacarbazine (ABVD) chemotherapy is a standard treatment for patients with Hodgkin's lymphoma. While the adverse effects of ABVD chemotherapy are well recognised, pulmonary edema is rarely observed as a complication. Bleomycin may induce pulmonary fibrosis, leading to a decline in pulmonary function and an increase in respiratory morbidity. The mechanism of Bleomycin-induced pulmonary fibrosis remains unclear. However, various studies suggest that it results from unopposed inflammation and Bleomycin's tendency to affect the lung parenchyma. In our case series of three patients, the first patient experienced an acute onset of dyspnoea following Bleomycin infusion and was in respiratory failure. He had normal echocardiogram findings, with high-resolution computed tomography (HRCT) revealing features consistent with pulmonary edema and fibrotic changes in the parenchyma. He was managed in the ICU with corticosteroids and empirical antibiotics, along with invasive ventilation, and recovered gradually from respiratory failure. His subsequent hospital stay was uneventful. In contrast, the other two patients showed pulmonary parenchymal changes and a decline in pulmonary function tests (in one patient) following Bleomycin-based chemotherapy. They were managed with pulmonary rehabilitation, along with treatment for their underlying disease.