Spontaneous Pneumomediastinum and Bilateral Pneumothoraces in a Patient with Bleomycin-Induced Pneumonitis

  • Matthieu Barras Division of Internal Medicine, Regional Hospital Riviera-Chablais, Monthey
  • Marc Uhlmann Division of Internal Medicine, Regional Hospital Riviera-Chablais, Monthey
Keywords: Bleomycin-induced pneumonitis, pneumomediastinum, pneumothorax

Abstract

Bleomycin lung toxicity is well established and can manifest as bleomycin-induced pneumonitis, but pneumomediastinum and pneumothorax are very rare complications. We report the case of a 73-year-old woman, recently treated with bleomycin for Hodgkin’s disease, who was admitted for bleomycin-induced pneumonitis. Two weeks later she had a pneumomediastinum with extensive subcutaneous emphysema and small bilateral pneumothoraces. Three months after that she was readmitted for dyspnoea. The CT scan showed complete regression of the pneumomediastinum but extensive bilateral ground-glass infiltrates. The patient died from respiratory failure 2 weeks later.

References

  • Frusch N, Servais S, De Prijck B, Corhay JL, Beguin Y, Louis R, et al. Spontaneous pneumomediastinum caused by bleomycin-induced pneumonitis. Acta Clin Belg 2012;67:370-371.

  • Araujo MS, Fernandes FL, Kay FU, Carvalho CR. Pneumomediastinum, subcutaneous emphysema, and pneumothorax after a pulmonary function testing in a patient with bleomycin-induced interstitial pneumonitis. J Bras Pneumol 2013;39:613–619.

  • Sikdar T, MacVicar D, Husband JE. Pneumomediastinum complicating bleomycin related lung damage. Br J Radiol 1998;71:1202–1204.

  • Jennane S, Haidouri S, Zine Filali K, Ahchouch S, Mahtat EM, Doghmi K, et al. Fatal bleomycin induced pneumomediastinum and bilateral pneumothorax. Rev Pneumol Clin 2017;73:153–156.

  • Namitha R, Nimisha KP, Yusuf N, Rauf CP. Air leak: an unusual manifestation of organizing pneumonia secondary to bleomycin. Lung India 2017;34:173–175.

  • Keijzer A, Kuenen B. Fatal pulmonary toxicity in testis cancer with bleomycin-containing chemotherapy. J Clin Oncol 2007;25:3543–3544.

  • Jain TP, Thulkar S, Saha S, Bakhshi S, Dominic J. Extensive pneumothorax, pneumomediastinum and surgical emphysema as a complication of bleomycin therapy. Pediatr Radiol 2005;35:1227–1229.

  • Briassoulis G, Hatzis T, Paphitis C, Stinios J. Acute spontaneous pneumomediastinum in a child with Hodgkin's disease and pulmonary fibrosis. Pediatr Hematol Oncol 1999;16:175–180.

  • Doll DC. Fatal pneumothorax associated with bleomycin-induced pulmonary fibrosis. Cancer Chemother Pharmacol 1986;17:294–295.

  • Leeser JE, Carr D. Fatal pneumothorax following bleomycin and other cytotoxic drugs. Cancer Treat Rep 1985;69:344–345.

  • Sleijfer S. Bleomycin-induced pneumonitis. Chest 2001;120:617–624.

  • Sahni S, Verma S, Grullon J, Esquire A, Patel P, Talwar A. Spontaneous pneumomediastinum: time for consensus. N Am J Med Sci 2013;5:460–464.

  • Grahmann PR, Brauer M, Hüter L, Sayer H, Neumann R, Braun RK. Respiratory failure and pulmonary fibrosis as a late side-effect after chemotherapy-induced by oxygen administration. Pneumologie 2005;59:763–769.

  • Svedbrand C, Lange P, Nielsen K. Spontaneous mediastinal emphysema. Ugeskr Laeger 2016;178:V08150653.

  • Caceres M, Ali SZ, Braud R, Weiman D, Garrett HE Jr. Spontaneous pneumomediastinum: a comparative study and review of the literature. Ann Thorac Surg 2008;86:962–966.

  • Fujiwara T. Pneumomediastinum in pulmonary fibrosis. Detection by computed tomography. Chest 1993;10444–46.
  • Published: 2017-10-09

    Issue: Vol 4 No 10 (view)

    Section: Articles

    How to cite:
    Barras, M., & Uhlmann, M. (2017). Spontaneous Pneumomediastinum and Bilateral Pneumothoraces in a Patient with Bleomycin-Induced Pneumonitis. European Journal of Case Reports in Internal Medicine, 4(10). https://doi.org/https://doi.org/10.12890/2017_000727