Rituximab and Pirfenidone in the Treatment of Steroid‐Refractory Bleomycin Lung Injury

TL;DR

A patient with steroid-resistant lung injury from chemotherapy improved with rituximab and pirfenidone, suggesting a new treatment option.

Contribution

This case highlights the potential use of rituximab and pirfenidone for steroid-refractory bleomycin-induced lung injury.

Findings

The patient showed significant clinical and radiological improvement after adding rituximab and pirfenidone.

Steroid-refractory bleomycin-induced lung injury may respond to combination therapy with these agents.

This case suggests a potential alternative therapeutic approach for managing severe BILI.

Abstract

Bleomycin‐induced lung injury (BILI) is a well‐recognised but potentially life‐threatening complication of ABVD chemotherapy (adriamycin, bleomycin, vinblastine and dacarbazine), often requiring prompt diagnosis and intervention. We present a case of a 43‐year‐old female with Hodgkin's lymphoma who developed progressive respiratory symptoms following her fourth cycle of ABVD. A broad infectious and autoimmune workup was unremarkable, and chest imaging was consistent with interstitial lung disease. Her condition deteriorated despite empirical antibiotics and high‐dose corticosteroids. The addition of rituximab and pirfenidone led to significant clinical and radiological improvement, highlighting the potential role of these agents in managing steroid‐refractory BILI.

Bleomycin‐induced lung injury (BILI) is a serious, potentially life‐threatening complication of ABVD chemotherapy. Diagnosis is often challenging and made by exclusion. Treatment becomes particularly difficult when corticosteroids fail, as alternative options are limited. This case demonstrates a favourable response to rituximab and pirfenidone, suggesting a potential alternative therapeutic approach.

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