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An event is serious (based on the ICH definition) when the patient outcome is:
* death
* life-threatening
* hospitalisation
* disability
* congenital anomaly
* other medically important event
A 40-year-old man developed fatal lung toxicity during treatment with bleomycin for testicular cancer.
The man had diabetes and testicular cancer. He was admitted with dyspnoea. Chest X-ray revealed increased reticular opacities in the upper and lower zones along with left lung multifocal scattered opacities in the perihilar region. Chest CT revealed an organised stage of coronavirus disease-2019 (COVID-19) pneumonia (differential diagnosis) associated with diffuse fibrotic changes. He was admitted and treated with azithromycin, hydroxychloroquine and ceftriaxone. However, based on PCR, respiratory pathogen test and sputum culture, he COVID-19 infection was excluded. Further, evaluation of medical history revealed he had received 3 cycles of bleomycin [dosage and route not stated], etoposide and cisplatin chemotherapy protocol. He also reported to have experienced shortness of breath for two months previously following the last dose. He was diagnosed with bleomycin-induced pneumonitis.
The man's treatment was discontinued, and his partial pressure of oxygen (PaO2) levels suddenly fell. Subsequent chest X-ray and chest CT scan revealed bleomycin-induced diffuse fibrosis, pulmonary interstitial pneumonia and spontaneous pneumomediastinum, pneumothorax and pulmonary interstitial emphysema. The diagnosis of bleomycin-induced lung toxicity was made [time to reaction onset not stated]. He was transferred to the ICU and a chest tube was inserted. However, he died from respiratory failure after a few hours.
Reference
- Koksal M, et al. Bleomycin-induced fatal lung toxicity misdiagnosed as covid-19 pneumonia: A case report. Respiratory Case Reports 10: 12-15, No. 1, Jan 2021. Available from: URL: 10.5505/RESPIRCASE.2021.78055 [DOI]