Eosinophilic pneumonia associated with bleomycin in a patient with mediastinal seminoma: a case report

Abstract

Introduction: Lung toxicities resulting from the chemotherapeutic agent bleomycin encompass a variety of pathological changes, including bronchiolitis obliterans organizing pneumonia, interstitial pneumonitis and progressive interstitial fibrosis. We report a rare case of eosinophilic pneumonia associated with bleomycin.

Case presentation: A 44-year-old Hispanic man with a primary mediastinal seminoma complicated by superior vena cava syndrome underwent treatment with four cycles of bleomycin, etoposide and cisplatin. He had a complete positive response to the chemotherapy. However, three months after treatment he presented with shortness of breath and severe hypoxemia associated with peripheral eosinophilia. Computed tomography showed bilateral diffuse interstitial infiltrates that were refractory to antibiotic treatment. A lung biopsy showed eosinophilic pneumonia. He was subsequently treated with high-dose prednisone, resulting in a complete resolution of his symptoms and lung infiltrates.

Conclusion: This case illustrates that eosinophilic pneumonia may be a late sequela of bleomycin toxicity, and may respond dramatically to steroid treatment.

Figure 1

Pulmonary infiltrates before and after steroid treatment. (A) Computed tomography (CT) of chest with intravenous contrast in March 2007 showing right upper lobe, right middle lobe and left lung with patchy ground-glass opacities. (B) CT of chest one month after steroid treatment showing complete resolution of ground-glass opacities in both lung fields.

Figure 2

Histology of pulmonary lesions. Hematoxylin and eosin stain was used for the lung biopsy, original magnification, 400×. Arrow points to eosinophils with pink color; alveoli are infiltrated with inflammatory cells, mainly eosinophils, lymphocytes and neutrophils. There is no evidence of vasculitis or alveolar hemorrhage. There is some fibrous tissue in the periphery. Note that only distal airways are involved with sparing of proximal airways.