Fatal pulmonary fibrosis from low-dose bleomycin therapy.

Six weeks after receiving a total dose of 20 units of bleomycin sulfate as part of BACOP therapy for non-Hodgkin's lymphoma, our patient had dyspnea and cough with marked hypoxemia. Open lung biopsy established the diagnosis of "bleomycin lung," confirmed by postmortem examination. Fatal bleomycin pulmonary toxicity can develop with any dosage, and routine tests are incapable of detecting early, reversible toxicity.