대한흉부영상의학회 Weekly Chest Cases

Case No : 286 Date 2003-04-19

Courtesy of Byoung Wook Choi, M.D., Kyu Ok Choe, M.D. / Yonsei University Sinchon Severance Hospital, Seoul, Korea
Age/Sex 33 / M
Chief ComplaintFever, known testicular tumor

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Diagnosis With Brief Discussion

Diagnosis: Bleomycin-Induced Lung Toxicity (BOOP Reaction)
Radiologic Findings: There are bilateral patchy consolidation and groung glass opacities with peripheral distribution on chest radiograph and CT.
Brief Review: Bleomycin is an antibiotic agent with antitumor activity. It is commonly used as part of the cytostatic treatment of several tumor types, such as germ-cell tumors, lymphomas, etc. Due to the lack of the bleomycin-inactivating enzyme, bleomycin hydrolase, in the lungs and the skin, bleomycin-induced toxicity occurs predominantly in these organs. The most feared and dose-limiting side effect of bleomycin is its induction of pulmonary toxicity. Several distinct pulmonary syndromes have been associated with the use of bleomycin, such as BOOP, eosinophilic hypersensitivity, and, the most commonly, interstitial pneumonitis, which ultimately may progress into fibrosis. Bleomycin, gold salts, cyclophsophamide, and methotrexate are the most common drugs that casue BOOP. Affected patients present with progressive dyspnea, dry cough, and fever. Chest radiographs demonstrate bilateral scattered heterogeneous and homogeneous opacities. These areas are typically peripheral in distribution and are equally distributed between the upper and lower lobes. CT often shows associated poorly defined nodular areas of consolidation, centrilobular nodules and branching linear opacities, and bronchial dilatation. BOOP caused by pulmonary drug toxicity typically responds well to cessation of drug therapy, but the patient may also require the administration of corticosteroids.
References: 1. Sleijfer S. Bleomycin-induced pneumonitis. Chest 2001; 120:617-624
2. Rossi SE, Erasmus FF, McAdams HP, Sporn TA, Goodman PC. Pulmonary drug toxicity: radiologic and pathologic manifestations. Radiographics 2000; 20:1245-1259
Keywords: Lung, Non-infectious inflammation, Drug complication, Bleomycin-Induced Lung Toxicity (BOOP Reaction)

No. of Applicants : 29

▶ Correct Answer : 15/29, 51.7%

- Annecy Hospital, France Stephane Hominal
- Busan Moonhwa Hospital, Korea Yoo Kyung Kim
- CHU Nancy-Brabois, France Denis Regent
- CIM Saint Dizier, France JC Leclerc
- Chung Li Ten-Chen Hospital,Taiwan Zheng gui-lin|
- Korea University Hospital, Korea Bo Kyung Je
- Maimonides Medical Center, USA Naomi Twersky
- MH(CTC), Pune, India Vivek Sharma
- National Medical Center, Korea Sang Kyu Yang
- Ohio State University, Ohio, USA Sumit Seth
- Ospedale di Jesi, Italy Giancarlo Passarini
- Seoul National University Hospital, Korea Jae-Joon Yim
- Seoul National University Hospital, Korea Jung-Gi Im
- Social Security Hospital, Turkey Meric Tuzun
- Tokyo Kouseinenkin Hospital , Japan Noriatsu Ichiba

▶ Semi-Correct Answer : 3/29, 10.3%

- Gwangmoung Seongae Hospital, Korea Jiyong Rhee
- Hangang Sacred Heart Hospital, Korea Eil Seong Lee
- Seoul National University Hospital, Korea Euna Park

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 286 Date 2003-04-19

Discussion

No. of Applicants : 29