Bleomycin-induced lung injury treated with venovenous extracorporeal membrane oxygenation (ECMO) and ultra-protective ventilator settings

BMJ Case Rep. 2020 Nov 23;13(11):e236474. doi: 10.1136/bcr-2020-236474.

Abstract

Bleomycin treats malignancies, such as germ cell tumours and Hodgkin lymphoma. While efficacious, it can cause severe drug-induced lung injury. We present a 42-year-old patient with stage IIB seminoma treated with radical orchiectomy followed by adjuvant chemotherapy with bleomycin, etoposide and cisplatin. His postbleomycin course was complicated by the rapid onset of hypoxic respiratory failure, progressing to acute respiratory distress syndrome and requiring venovenous extracorporeal membrane oxygenation (VV-ECMO) support. Although the patient was treated with high dose systemic steroids and ultra-protective ventilator strategies to minimise ventilator-induced lung injury while on VV-ECMO, his lung injury failed to improve. Care was withdrawn 29 days later. Lung autopsy revealed diffuse organising pneumonia. We found six case reports (including this one) of bleomycin-induced lung injury requiring VV-ECMO with a cumulative survival of 33% (2/6). While VV-ECMO may be used to bridge patients to recovery or lung transplant, the mortality is high.

Keywords: cardiothoracic surgery; chemotherapy; drugs: respiratory system; intensive care; mechanical ventilation.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Antibiotics, Antineoplastic / adverse effects
  • Bleomycin / adverse effects*
  • Equipment Design
  • Extracorporeal Membrane Oxygenation / methods*
  • Humans
  • Lung Injury / chemically induced*
  • Lung Injury / diagnosis
  • Lung Injury / therapy
  • Male
  • Respiration, Artificial / methods*
  • Seminoma / therapy
  • Testicular Neoplasms / therapy
  • Ventilators, Mechanical*

Substances

  • Antibiotics, Antineoplastic
  • Bleomycin