Abstract Patient initially presented for a testicular mass at age 21, diagnosed as a mixed germ cell tumor. He proceeded through orchiopexy and chemotherapy with 4 cycles of bleomycin, etoposide, and cisplatin (BEP) and started developing fatigue and shortness of breath after his final cycle. Spirometry and DLCO were normal until his 4th cycle, when he had decline in his FEV1 and DLCO to 76pp corrected for hemoglobin. Chest CT demonstrated subpleural, lower lobe predominant ground glass opacities. Flexible bronchoscopy was completed at this time with expanded infectious study testing and was unremarkable. He subsequently underwent a retroperitoneal lymph node dissection, and 2 months after his last BEP cycle DLCO was 65pp corrected for hemoglobin and subpleural opacities persisted. This was consistent with an organizing pneumonia, a known complication of bleomycin, and he was subsequently started on high dose steroids and after 4 weeks on 100 mg and 2 weeks on 50 mg dose DLCO corrected improved to 82pp. He has had some challenges with drop in his DLCO corrected with weaning steroids, and 18 months later is stable on 20 mg/day of Prednisone.Patient’s total bleomycin dosing was 173 units/m2, which is usually below the toxicity threshold. Prior to starting treatment, he did vape nicotine frequently, often taking more than 30 puffs/day; this was his only possible risk factor. While cigarette smoking has been a well described risk factor for bleomycin toxicity at low doses, less is known about the effects of vaping on inducing lung injury, especially in young adult patients; this patient’s course raises concern that vaping may be an additional risk factor for injury and should be discussed with patients. This abstract is funded by: None
Wynn et al. (Fri,) studied this question.