Flagellate pigmentation from intrapleural bleomycin. A light microscopy and electron microscopy study

A case is presented of a 65-year-old white man with left pleural mesothelioma treated with a single intrapleural instillation of bleomycin for cavitary sclerosis. One month later the patient developed pigmented flagellate streaks on his arms and chest wall. To our knowledge, this is the first case in the literature showing these typical pigmentary changes in which a single small dose of bleomycin acted as an intrapleural sclerosing agent.