Although there has been increased utilization of bleomycin in the treatment of low-flow vascular malformations in children, previous studies report minor adverse effects limited to skin changes/necrosis and flu-like symptoms (Horbach et al. in J Plast Reconstr Aesthet Surg 69(3):295-304, 2016). However, there have been rare reported cases of pulmonary injury observed in children after bleomycin intralesional administration. We report a case of fatal lung toxicity in a 15-month-old girl after injecting 7 units of bleomycin into a left cheek macrocystic lymphatic malformation. 1 week after therapy, she developed respiratory distress with imaging findings of pneumothorax and diffuse alveolar damage. Despite extensive management and resuscitative efforts of presumed pneumonitis, further decline resulted in death via respiratory failure. Early detection of pulmonary toxicity would allow prompt therapy and could avoid significant pulmonary damage.

中文翻译：

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博莱霉素硬化血管内畸形硬化治疗后的致命肺毒性。

尽管博莱霉素在儿童低流量血管畸形的治疗中得到了越来越多的利用，但先前的研究报道了轻微的不良反应，仅限于皮肤变化/坏死和类似流感的症状（Horbach等在J Plast Reconstr Aesthet Surg 69（ 3）：295-304，2016）。然而，很少有报道报道博莱霉素病灶内给药后患儿发生肺损伤。我们报告了在向左颊大囊性淋巴畸形注射7个单位的博来霉素后，在一个15个月大的女孩中发生致命的肺毒性病例。治疗后1周，她出现呼吸窘迫，影像学表现为气胸和弥漫性肺泡损伤。尽管对假定的肺炎进行了广泛的管理和复苏努力，但进一步下降导致呼吸衰竭导致死亡。