Bleomycin Overdose in a Patient with Stage II Hodgkin Lymphoma: A Case Report of a Medication Error

Abstract

Bleomycin is an antibiotic with cytotoxic properties, commonly used in combination regimens for the treatment of Hodgkin lymphoma. The inconsistency in dosage nomenclature of bleomycin seems to be universal in many countries, which increases the risk of medication error. However, as far as we know no cases have reported. Here we present a case report of a medication error caused by bleomycin overdose. A 25-year-old patient with Stage II Hodgkin Lymphoma received a 150 USP bleomycin, which dosage was ten times higher than usually used, as part of the doxorubicin, bleomycin, vindesine, dacarbazine protocol (ABVD) at the third cycles of chemotherapy. After the medication error was found, the patient was immediately treated with intravenous rehydration and furosemide to promote clearance of drugs. To prevent lung injury, the methylprednisone and acetylcysteine was given. The patient developed a slight nausea and a mild rash, which gradually improved after the treatment. After the evaluation with PET-CT, the patient received four cycles of AVD chemotherapy. During the treatment and one-year follow-up period, no other obvious abnormalities were observed. The toxicities, clinical managements and selection of further chemotherapy after bleomycin overdose deserved serious attention in this case. More importantly, the management measures after this error can be used for reference in other hospitals.