Atypical radiological presentation of bleomycin-induced lung injury: Case report and review of literature

Bleomycin-induced lung injury manifesting after chemotherapy in patients with Hodgkin's disease is a known fatal entity. The histological picture encompasses from alveolar haemorrhage to diffuse alveolar damage, and the clinical picture is similar to that of interstitial pneumonitis. Radiologically, it is a spectrum of ground-glass opacities and infiltrates to finally consolidation and later fibrosis. This patient presented with atypical radiological sequelae of pneumomediastinum and extensive subcutaneous emphysema. The patient was managed in the intensive care unit with an intercostal drain, mechanical ventilation and vasopressor support. After a week, the intercostal drain was removed, and the patient was weaned off the ventilatory support. The patient was subsequently tracheostomised and shifted to the general ward. This case throws light on the rare radiological pattern of bleomycin-induced lung toxicity that can complicate the management of such patients.