A case of bleomycin-induced scleroderma

Abstract

The association of exposure to bleomycin with the development of scleroderma-like cutaneous abnormalities has been reported. We experienced a case of scleroderma involving the hands, feet, and forearms after bleomycin chemotherapy. The present report supports the possible causal relation of bleomycin with scleroderma. Regarding the widespread use of bleomycin, this complication is thought to be under appreciated.

Flagellate erythema

“…A case of flagellate erythema showing histological dermal sclerosis treated with bleomycin with a total dose of 45 mg has been reported 24 . Scleroderma is reported to be developed in patients under systemic bleomycin therapy 35–38 . Also, local bleomycin treatment induces dermal fibrosis 39 and sclerosis 40 in rodents.…”

Drug-induced morphea: Report of a case induced by balicatib and review of the literature

“…14,15 Sclerotic lesions were usually preceded by erythematous lesions, variably itchy (5/15) 11,12,15,19,20 or associated with tingling or burning sensation (2/15). 9,14 Cases associated with L-5-hydroxytryptophane and carbidopa showed hypereosinophilia 14,15 ; some patients with bleomycin-associated scleroderma showed Raynaud's phenomenon, sclerodactyly, cutaneous calcinosis, lung involvement, and weakly positive reaction for antinuclear antibodies. 9 In many instances, withdrawal of the culprit drug was not sufficient to obtain complete remission, suggesting that the drug was the trigger exacerbating an underlying scleroderma.…”

“…9,14 Cases associated with L-5-hydroxytryptophane and carbidopa showed hypereosinophilia 14,15 ; some patients with bleomycin-associated scleroderma showed Raynaud's phenomenon, sclerodactyly, cutaneous calcinosis, lung involvement, and weakly positive reaction for antinuclear antibodies. 9 In many instances, withdrawal of the culprit drug was not sufficient to obtain complete remission, suggesting that the drug was the trigger exacerbating an underlying scleroderma. In our case, we treated the patient with a brief course of systemic steroids because at the time of lesion appearance we did not know whether she was receiving the active drug or placebo.…”

Bleomycin and the skin

“…Systemic sclerodermatous changes have been reported to occur in patients with underlying cancer or haematological malignancies during or following systemic chemotherapy involving bleomycin 77–80 . In one case, bleomycin was administered by intrapleural injection 78 .…”

“…Systemic sclerodermatous changes have been reported to occur in patients with underlying cancer or haematological malignancies during or following systemic chemotherapy involving bleomycin. [77][78][79][80] In one case, bleomycin was administered by intrapleural injection. 78 Most patients were male, and the cumulative dose of bleomycin varied between 51 and 780 U. Antinuclear antibodies were occasionally present, 78 leading eventually to the development of flagellate erythema, but whether these were induced by bleomycin or present prior to bleomycin therapy is uncertain.…”