Bleomycin lung toxicity is well established and can manifest as 
bleomycin-induced pneumonitis, but pneumomediastinum and pneumothorax are very 
rare complications. We report the case of a 73-year-old woman, recently treated 
with bleomycin for Hodgkin's disease, who was admitted for bleomycin-induced 
pneumonitis. Two weeks later she had a pneumomediastinum with extensive 
subcutaneous emphysema and small bilateral pneumothoraces. Three months after 
that she was readmitted for dyspnoea. The CT scan showed complete regression of 
the pneumomediastinum but extensive bilateral ground-glass infiltrates. The 
patient died from respiratory failure 2 weeks later.
LEARNING POINTS: Respiratory investigation before initiation of bleomycin 
treatment and then close follow-up during treatment of any abnormalities found 
is mandatory, as bleomycin -induced toxicity can lead to fibrosis and secondary 
pneumothorax/pneumomediastinum with high morbidity/mortality.Bleomycin-induce 
pneumonitis (BIP) is managed with bleomycin discontinuation (Grade 1A) and 
system corticosteroid (Grade 1B).Supplemental oxygen is discouraged for BIP, but 
indicated for conservative management of pneumothoraces, so this case was 
managed with limited oxygen supplementation (aiming for oxygen saturation of 
92-94%).