BLEOMYCIN-INDUCED PSS-LIKE SCLERODERMA - CASE-REPORT AND REVIEW OF THE LITERATURE

Although the association between administration of the antitumor agent bleomycin a nd the development of cutanous fibrosis is establish ed, there a re on ly a sma II number of cases of bleomycin-induced sclerod erma described in the literature. We report the development of general ised scleroderma with wide spread hyperpigmentation in a 52-year-old m ale patient, who received a total dose of 360 mg bleomycin in combinat ion with cisplatin and etoposid for therapy of a malignant testicular seminoma. The clinical cutaneous alterations as well as the histologic al findings were indistinguishable from those encountered in progressi ve systemic sclerosis (PSS). In contrast to PSS however, Raynaud's phe nomenon, cutaneous calcinosis, teleangiectasia, arthritis and involvem ent of additional organs were all absent. PSS-typical auto-antibodies were negative. Even 18 months after discontinuation of the drug and tr eatment with UVA(1) phototherapy (3-4 times per week with 20 J/cm(2)) as well as physiotherapy, the skin changes had still not resolved. Bas ed on our case and a detailed review of the literature, we discuss cha racteristics of bleomycin-induced scleroderma including pathogenesis, treatment modalities and course.