Shahid Javed Husain, Ali Bin Sarwar Zubairi, Muhammad Irfan.
Bleomycin induced pneumonitis: a case successfully managed with high-dose steroids.
J Pak Med Assoc Jan ;57(2):91-2.

A 59 year old male with a history of Hodgkin`s lymphoma which was treated with 6 cycles of ABVD (adriamycin, bleomycin, vincristine, doxorubicin) completed one month ago, presented to the hospital with a 2 week history of low grade fever and cough accompanied by dyspnoea and right sided pleuritic chest pain. On physical examination he was in mild distress. The BP was 110/70 mmHg, pulse was 100/min, RR 28/min and oxygen saturation of 88% on room air, which increased to 96% on 4 L nasal oxygen. On chest examination he had harsh breath sounds and crackles at the bases bilaterally. His chest radiograph showed subtle increase density in both lung bases. He was started on intravenous ceftriaxone and clarithromycin. A fibreoptic bronchoscopy with broncho alveoalar lavage was done. The gram stain and culture sensitivity, acid fast bacilli smear and fungal cultures were all negative. The BAL cell count was not done due to its low specificity. A high resolution CT scan of chest was performed which showed diffuse ground glass opacification on both lower lung zones and pleural based nodules. These findings were highly suggestive of bleomycin induced pneumonitis (BIP).

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