Fatal interstitial pneumonitis induced by low dosage of bleomycin in an esophageal cancer patient.

One-shot intratumor injection of 60 mg oil-bleomycin prior to subtotal esophagectomy induced fatal, acute interstitial pneumonitis in a 53 year-old esophageal circinoma patient. The progression of bleomycin-induced pneumonitis was rapid and the patient succumbed to respiratory insufficiency 41 days after surgery (58 days after bleomycin administration). Autopsy revealed bilaterally increased lung weight and the organ was of rubbery consistency and anthracotic. Histology showed advanced interstitial fibrosis, numerous lymphocytes in alveolar septi and fibrinous exudate, macrophages and desquamative cells within the alveolar spaces. In the present case, pneumonitis was due not to patient age or dosage level of bleomycin, but rather to the administration method.