The relative absence of immunosuppression and myelosuppression with bleomycin makes it an indispensable component of chemotherapy in Hodgkin lymphoma (HL) and germ cell tumours (GCT) However, bleomycin induced pulmonary toxicity (BIP) is a significant limitation and may affect treatment outcomes in cancer patients in absence of any approved standard treatment. We reviewed the imaging findings of five patients with bleomycin toxicity from the radiology database, who presented to our hospital from January to July 2019. The index cases were aged between 5 to 63years. Three of the patients had Hodgkin lymphoma, one patient had anaplastic non-Hodgkin lymphoma (NHL) and one patient was diagnosed with nonseminomatous germ cell tumour(NSGCT). They received ABVD (Adriamycin, bleomycin, vincristine and dacarbazine) for lymphoma and BEP (Bleomycin, etoposide and cisplatin) chemotherapy regimen for NSGCT. All patients underwent CTimaging. Additional ultrasound was performed for two patients. Four of the patients developed clinical features of drug toxicity with corroborative HRCT appearances during the course of treatment. Bleomycin was withheld from the subsequent drug regimens and no recurrence of the pulmonary symptoms was noted. One patient showed HRCT evidence of BIP after completion of his chemotherapy, albeit without clinical correlate. This suggested subclinical toxicity and did not significantly affect the patient’s performance status. Bleomycin induced pulmonary toxicity affects the clinical course of patients with Hodgkin lymphoma and germ-cell tumour and can be fatal in 2-3% of the cases. Imaging plays an adjunctive role in the diagnosis of this condition and can prompt further clinical evaluation in subclinical cases.

The relative absence of immunosuppression and myelosuppression with bleomycin makes it an indispensable component of chemotherapy in Hodgkin lymphoma (HL) and germ cell tumours (GCT) However, bleomycin induced pulmonary toxicity (BIP) is a significant limitation and may affect treatment outcomes in cancer patients in absence of any approved standard treatment. We reviewed the imaging findings of five patients with bleomycin toxicity from the radiology database, who presented to our hospital from January to July 2019. The index cases were aged between 5 to 63years. Three of the patients had Hodgkin lymphoma, one patient had anaplastic non-Hodgkin lymphoma (NHL) and one patient was diagnosed with nonseminomatous germ cell tumour(NSGCT). They received ABVD (Adriamycin, bleomycin, vincristine and dacarbazine) for lymphoma and BEP (Bleomycin, etoposide and cisplatin) chemotherapy regimen for NSGCT. All patients underwent CTimaging. Additional ultrasound was performed for two patients. Four of the patients developed clinical features of drug toxicity with corroborative HRCT appearances during the course of treatment. Bleomycin was withheld from the subsequent drug regimens and no recurrence of the pulmonary symptoms was noted. One patient showed HRCT evidence of BIP after completion of his chemotherapy, albeit without clinical correlate. This suggested subclinical toxicity and did not significantly affect the patient’s performance status. Bleomycin induced pulmonary toxicity affects the clinical course of patients with Hodgkin lymphoma and germ-cell tumour and can be fatal in 2-3% of the cases. Imaging plays an adjunctive role in the diagnosis of this condition and can prompt further clinical evaluation in subclinical cases.