Bleomycin Hypersensitivity Pneumonitis

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Abstract
Three cancer patients developed radiologic and functional pulmonary changes after bleomycin therapy similar to those previously associated with administration of this drug. Biopsy specimens showed a pattern consistent with hypersensitivity pneumonitis rather than the interstitial pneumonia usually reported in bleomycin pulmonary toxicity. There was a patchy eosinophilic infiltrate surrounding small airways and distal air spaces, but no immune deposits were noted by ultrastructure or immunofluorescence using conventional techniques and a specific antibody against bleomycin. Two patients had peripheral eosinophilia of 12 and 16%. All 3 patients showed considerable improvement on chest roentgenogram after corticosteroid treatment. The findings are consistent with the view that bleomycin hypersensitivity pneumonitis has a different pathogenesis than bleomycin interstitial pneumonitis. Its recognition as a separate entity seems warranted because of the favorable response to steroid therapy.