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

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.