FELD better not thinking of metastases only when liver lesions appear after bleomycin-based treatment for non-seminoma testis from metastases

Filip Yfl De Vos,Sasja F Mulder,Joost Ph Drenth,Jurgen J Fütterer,Iris D Nagtegaal,Winette Ta Van Der Graaf

doi:10.1186/1471-2407-13-491

Filip Yfl De Vos, Sasja F Mulder + Show 4 more

Open Access

https://doi.org/10.1186/1471-2407-13-491

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Abstract

BackgroundBleomycin has become an integral part of chemotherapy in patients with germ-cell tumors. One of the most feared side effects is bleomycin-induced pneumonitis. In patients with mild or moderate BIP, radiological signs disappear almost completely within nine months after discontinuation of bleomycin treatment.Case presentationWe present a patient with a history of non seminoma of the testis and bleomycin-induced pneumonitis. During follow-up, regression of the hypothesis of eosinophilic migration to the liver after regression of bleomycin-induced pneumonitis is highly suspicious based on transient eosinophilia and focal eosinophilic liver disease.ConclusionAs follow up may consist of CT scanning in germ-line tumor patients, transient eosinophilic liver lesions reported during regressive bleomycin-induced pneumonitis should not be presumed automatically as metastatic tumor relapse and require further sequential imaging and pathological examination.

Highlights

Bleomycin has become an integral part of chemotherapy in patients with germ-cell tumors
Bleomycin acts as an oncolytic agent by inducing DNA strand breakage and subsequent has become an integral part of chemotherapy in patients with germ-cell tumors [1,2]
We have seen the concomittant regression of bleomycin-induced pneumonitis (BIP) and onset of focal eosinophilic liver disease (FELD) with eosinophilia

Summary

Conclusion

In this patient the hypothesis of eosinophilic migration to the liver after regression of BIP is suggestive given the transient eosinophilia and presence of FELD. As follow up may consist of CT scanning in germ-line tumor patients, transient eosinophilic liver lesions reported during regressive BIP should not be presumed automatically as metastatic tumor relapse and require further sequential imaging and pathological examination. Consent Patient has given his consent for publication of casereport. Competing interests No funding sources need to be credited. Authors’ contributions IN provided the figures of pathological findings. JF provided the figures of radiological findings. All authors read and approved the final manuscript

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