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Bleomycin Lung Toxicity — RACP Adult Medicine MCQ

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ModerateRespiratoryBleomycin Lung ToxicityRACP Adult Medicine

A 45-year-old woman presents with cough and dyspnoea 4 weeks after completing chemotherapy with bleomycin for Hodgkin lymphoma. HRCT shows bilateral basal ground-glass opacities and early fibrotic change. Spirometry shows a restrictive pattern with reduced DLCO. What is the most likely diagnosis?

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Correct answer: A — Drug-induced pneumonitis

Bleomycin pulmonary toxicity is dose-dependent (cumulative dose >300 mg) and presents with progressive dyspnoea, basal predominant GGO and fibrosis, and restrictive spirometry. It can be fatal. Risk factors include age >40, renal impairment, concurrent radiation, and high FiO₂ exposure. DLCO monitoring during treatment can detect early toxicity.

Reference: eTG Respiratory – 2024 – Drug-Induced ILD; AMH 2025