Pulmonary fibrosis after prolonged therapy with 1,3-bis (2-chloroethyl)-1-nitrosourea

A 43-year-old man with metastatic malignant melanoma was treated with 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU) in combination with imidazole carboxamide and hydroxyurea. He achieved complete remission. After 22 months of chemotherapy, the patient developed bilateral pulmonary infiltrates. Open lung biopsy showed sclerosing alveolitis. Long-term therapy with BCNU may cause pulmonary fibrosis, as has been seen with other cytotoxic drugs.