Hyperpyrexia, allergic-type response and death occurring with low-dose bleomycin administration

This is a case report of hyperpyrexia, shock and death following initial injection of low-dose bleomycin (7.5 units) for a poorly differentiated metastatic carcinoma. Premedication with high-dose dexamethasone and acetaminophen did not abort the reaction. A review of the literature uncovered one nearly fatal reaction to a test dose of 1 unit of bleomycin All previously reported fatal cases were in patients with lymphoma who had received an initial dose of at least 25 units/m2. Since the 'safe' test dose of bleomycin is not known, test doses of 1 unit or lower should be routinely used; the effect of premedication is also unclear.