Bleomycin


Cytostatic agent produced by a strain of Streptomyces verticillus. Bleomycin inhibits cell cleavage by blocking the uptake of thymidine by DNA and leading to weakening and break-up of DNA chains.
 
Incidence
Fever: 20 to 25% of patients.
 
Fulminant reactions: 1 to 8% of patients.
 
Deaths reported.
 
Risk factors
Lymphoma (for fulminant reactions).
 
Intravenous administration.
 
Clinical manifestations
General: fever, hypotension.
 
Cutaneous: pruritus, flagellate dermatitis, angioedema, toxic epidermal necrolysis, erythematous rash.
 
Respiratory: eosinophilic pneumonia, fibrosis.
 
Diagnostic methods
No in vivo or in vitro method is currently available for diagnosis.
 
Mechanisms
Non immunological mechanisms are likely.
 
Management
Antihistamines and corticosteroids are sometimes effective.

References

  1. Haerslev T, Avnstorp C, Joergensen M, "Sudden onset of adverse effects due to low-dosage bleomycin indicates an idiosyncratic reaction", Cutis., 1993; 52 (1): 45-6
  2. Yousem S.A, Lifson J.D, Colby T.V, "Chemotherapy-induced eosinophilic pneumonia. Relation to bleomycin", Chest., 1985; 88 (1): 103-6
  3. Khansur T, Little B, Tavassoli M, "Fulminant and fatal angioedema caused by bleomycin treatment", Arch. Intern. Med., 1984; 144 (11): 2267

As in all diagnostic testing, the diagnosis is made by the physican based on both test results and the patient history.