Elsevier

Mayo Clinic Proceedings

Volume 66, Issue 2, February 1991, Pages 173-178
Mayo Clinic Proceedings

Case Report
Oxygen-Exacerbated Bleomycin Pulmonary Toxicity

https://doi.org/10.1016/S0025-6196(12)60489-3Get rights and content

Bleomycin is an antineoplastic agent with potential for producing pulmonary toxicity, attributed in part to its free radical-promoting ability. Clinical and research experiences have suggested that the risk of bleomycin-induced pulmonary injury is increased with the administration of oxygen. We report a case in which the intraoperative administration of oxygen in the setting of previous bleomycin therapy contributed to postoperative ventilatory failure. Our patient recovered with corticosteroid therapy. Physician awareness of a potential interaction between oxygen and bleomycin may help reduce the morbidity and mortality related to bleomycin therapy.

Section snippets

REPORT OF CASE

A previously healthy 28-year-old man sought medical assistance from his local physician on July 4, 1988, because of right-sided chest pain, dysphagia, and severe sore throat. He had a 20-pack-year history of use of tobacco. A chest roentgenogram revealed a right-sided anterior mediastinal mass. A computed tomographic scan of the chest demonstrated multiple pulmonary nodules bilaterally and confirmed the presence of an anterior mediastinal mass. A right thoracotomy was performed. Tissue obtained

DISCUSSION

In 1978, Goldiner and associates7 described five consecutive patients who received 135 to 595 U of bleomycin for testicular cancer and subsequently had adult respiratory distress syndrome that progressed to death within 3 to 5 days after retroperitoneal lymph node biopsy or removal of pulmonary metastatic lesions. During the surgical procedure, they received supplemental oxygen (a mean of 39%; range, 35 to 42%). The operation was performed within 6 to 12 months after bleomycin treatment.

CONCLUSION

The anesthesiologist and the surgeon must be made aware of any history of bleomycin treatment; the clinician must also be certain that the anesthesiologist is familiar with the increased risk of pulmonary injury associated with a fractional concentration of oxygen in inspired gas of more than 0.3 and prior bleomycin treatment. Our case is similar to other cases of respiratory failure attributed to oxygen-exacerbated bleomycin toxicity reported in the literature. A surgical procedure before the

ACKNOWLEDGMENT

We thank Thomas V. Colby, M.D., for interpreting the pathologic specimens and Sharon M. Peterson, Patricia A. Muldrow, and Lori L. Oeltjenbruns for secretarial assistance in preparing the submitted manuscript.

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