A 54-year-old man with advanced non-Hodgkin's lymphoma and chronic renal insufficiency was treated with combination chemotherapy which included bleomycin. Fatal pulmonary toxicity developed after administration of a total bleomycin dose of only 60 U. Transbronchial biopsy and autopsy demonstrated pathologic findings consistent with bleomycin-induced pulmonary fibrosis. High-dose corticosteroid therapy did not appear to alter the clinical course. Extreme caution should be exercised when administering bleomycin to patients with renal insufficiency.