The cytotoxic agent bleomycin is feared for its induction of sometimes
fatal pulmonary toxicity, also known as bleomycin-induced pneumonitis
(BIP). The central event in the development of BIP is endothelial damage
of the lung vasculature due to bleomycin-induced cytokines and free
radicals. Ultimately, BIP can progress in lung fibrosis. The diagnosis is
established by a combination of clinical symptoms, radiographic
alterations, and pulmonary function test results, while other disorders
resembling BIP have to be excluded. Pulmonary function assessments most
suitable for detecting BIP are those reflecting lung volumes. The widely
used transfer capacity of the lungs for carbon monoxide appeared recently
not to be specific when bleomycin is used in a polychemotherapeutic
regimen. There are no proven effective treatments for BIP in humans,
although corticosteroids are widely applied. When patients survive BIP,
they almost always recover completely with normalization of radiographic
and pulmonary function abnormalities. This review focuses on BIP,
especially on the pathogenesis, risk factors, and its detection
