Chemotherapy-induced Eosinophilic Pneumonia: Relation to Bleomycin

doi:10.1378/chest.88.1.103

Chest

Volume 88, Issue 1, July 1985, Pages 103-106

https://doi.org/10.1378/chest.88.1.103 Get rights and content

Three cases of eosinophilic pneumonia are associated with bleomycin chemotherapy. As opposed to the more common picture of diffuse alveolar damage, these cases appear to represent a hypersensitivity reaction resembling eosinophilic pneumonia.

Section snippets

CASE 1

This 34-year-old woman presented in April 1980 with left supraclavicular lymphadenopathy. Biopsy showed nodular sclerosing Hodgkin's disease. Paratracheal and para-aortic lymphadenopathy were identified and she was staged as clinical IIIB Hodgkin's disease. She received one cycle of MOPP and five cycles of COPP chemotherapy (dosage unknown), which was completed in November 1980. In May 1981, she presented with severe low back pain. Abdominal CT scan showed a large retroperitoneal mass. A 10 cm

HISTOLOGIC FINDINGS

All three lung biopsy specimens showed similar histologic features—those of an eosinophilic pneumonia with focal organization (FIGURE 1, FIGURE 2). Consolidative alveolar infiltrates consisted of varying proportions of eosinophils and histiocytes. Both patients 1 and 2 had lakes of eosinophils distending air spaces and forming small eosinophilic microabscesses with granular central necrosis. Charcot-Leyden crystals were not identified. Patient 2 had a predominant population of finely pigmented

DISCUSSION

Eosinophilic pneumonia is a reactive pulmonary process characterized histologically by intra-alveolar masses of eosinophils and histiocytes.9, 10, 11, 12 Patients are usually quite ill with fever, chills, dyspnea, and a productive cough with sputum rich in eosinophils. Peripheral blood eosinophilia is also frequent. In classic cases, roentgenograms show a patchy peripheral infiltrate with perihilar sparing—the so-called “photographic negative of pulmonary edema.”¹³ A dramatic response to

ACKNOWLEDGMENT

Richard Coffin rendered photographic assistance, and Margaret Beers provided secretarial services.

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: Manuscript received October 4; revision accepted December 7.

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Chest

Chemotherapy-induced Eosinophilic Pneumonia: Relation to Bleomycin

Section snippets

CASE 1

HISTOLOGIC FINDINGS

DISCUSSION

ACKNOWLEDGMENT

Br J Dis Chest

Chest

J Allerg Clin Immunol

J Allerg Clin Immunol

Europ J Cancer

Chest

Bleomycin pulmonary toxicity

A clinical review of bleomycin–a new antineoplastic agent

Cancer

Pulmonary toxicity induced by Pepleomycin 3-[(s)-l-Phenylethylamino] Propylamino-bleomycin

Jap J Clin Oncol

Acute bleomycin lung

Am Rev Respir Dis

Interstitial pneumonitis associated with bleomycin therapy

Am J Clin Pathol

Pulmonary toxicity due to bleomycin

Arch Pathol

Chronic eosinophilic pneumonia

Thorax

Chronic eosinophilic pneumonia

N Engl J Med

The eosinophilic pnseumonias

Medicine

Chronic eosinophilic pneumonia: a follow-up study

Mayo Clin Proc