Flagellate pigmentation from intrapleural bleomycin. A light microscopy and electron microscopy study

Our plain-English summary of Flagellate pigmentation from intrapleural bleomycin. A light microscopy and electron microscopy study, by A.C. Fernandez-Obregon, K.P. Hogan, M.K. Bibro (Journal of the American Academy of Dermatology, 1985).

The study

• Authors: A.C. Fernandez-Obregon, K.P. Hogan, M.K. Bibro
• Journal: Journal of the American Academy of Dermatology
• Published: 1985;13(3):464-8
• Type of article: Case report
• Cited by: 22 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

A case is presented of a 65-year-old white man with left pleural mesothelioma treated with a single intrapleural instillation of bleomycin for cavitary sclerosis. One month later the patient developed pigmented flagellate streaks on his arms and chest wall. To our knowledge, this is the first case in the literature showing these typical pigmentary changes in which a single small dose of bleomycin acted as an intrapleural sclerosing agent.

In plain English

This case report described a 65-year-old white man with a 3-year history of left pleural mesothelioma and a history of previous exposure to asbestos. The article gave no details of that exposure. After drainage of a large left pleural effusion and an earlier tetracycline treatment, he received a single intrapleural instillation of 30 mg of bleomycin in December 1982 to seal the pleural space (cavitary sclerosis). One month later, pigmented streaks in a whip-like (flagellate) pattern appeared on his arms and chest wall. Skin biopsies showed extra melanin in the skin's basal layer. Under the electron microscope, pigment-producing cells were normal in number, but surrounding skin cells contained more pigment granules than usual. Four months after the bleomycin, the streaks were still present. The authors judged that tetracycline or doxorubicin could reasonably be excluded as causes. They concluded that, to their knowledge, this was the first reported case of these typical bleomycin pigment changes after such a small dose and after use as a sclerosing agent, and that the mechanism is unknown.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report
• Who was studied: One patient: a 65-year-old white man with a 3-year history of left pleural mesothelioma, with previous asbestos exposure and over 50 years of tobacco use, seen at a naval hospital (Bethesda, MD).
• Exposure: The exposure studied was a single intrapleural instillation of 30 mg of bleomycin, used as a sclerosing agent in December 1982. The patient had earlier received intrapleural tetracycline and later one treatment of doxorubicin (50 mg/m2, January 1984). Previous asbestos exposure was mentioned without fiber type, job or dose.
• Main results:
  • Pigmented streaks first appeared on the patient's arms and chest wall one month after the bleomycin instillation.
  • Light microscopy of a biopsy of the pigmented skin showed hyperpigmentation of the basal layer, confirmed to be melanin with Fontana-Masson stains. The rest of the epidermis and dermis was normal.
  • Electron microscopy showed melanocytes normal in number and appearance, but keratinocytes contained an increased number of melanosomes, mostly forming dense rings around the nucleus.
  • The melanosomes measured 0.5 to 1.0 micrometres long and 0.3 to 0.5 micrometres wide.
  • Four months after receiving bleomycin, the patient still had the streaks.
  • The authors considered that, because the flagellate pattern was typical of bleomycin, tetracycline or doxorubicin could reasonably be excluded as the cause.
• The authors' conclusion: The authors concluded that, to their knowledge, this was the first reported case of the typical bleomycin pigment changes following such a small dose (30 mg) and following use of bleomycin as an intracavitary sclerosing agent. They stated that the exact mechanism is unknown.
• Limitations the authors state:
  • The authors noted that their study did not measure the rate at which melanosomes were transferred to keratinocytes, which their proposed explanation involves.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma.

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