Fatal Lung Toxicity After Intralesional Bleomycin Sclerotherapy of a Vascular Malformation.

Although there has been increased utilization of bleomycin in the treatment of low-flow vascular malformations in children, previous studies report minor adverse effects limited to skin changes/necrosis and flu-like symptoms (Horbach et al. in J Plast Reconstr Aesthet Surg 69(3):295-304, 2016). However, there have been rare reported cases of pulmonary injury observed in children after bleomycin intralesional administration. We report a case of fatal lung toxicity in a 15-month-old girl after injecting 7 units of bleomycin into a left cheek macrocystic lymphatic malformation. 1 week after therapy, she developed respiratory distress with imaging findings of pneumothorax and diffuse alveolar damage. Despite extensive management and resuscitative efforts of presumed pneumonitis, further decline resulted in death via respiratory failure. Early detection of pulmonary toxicity would allow prompt therapy and could avoid significant pulmonary damage.

Duration of a minor epidemic.

Disease outbreaks in stochastic SIR epidemic models are characterized as either minor or major. When ℛ 0 < 1 , all epidemics are minor, whereas if ℛ 0 > 1 , they can be minor or major. In 1955, Whittle derived formulas for the probability of a minor or a major epidemic. A minor epidemic is distinguished from a major one in that a minor epidemic is generally of shorter duration and has substantially fewer cases than a major epidemic. In this investigation, analytical formulas are derived that approximate the probability density, the mean, and the higher-order moments for the duration of a minor epidemic. These analytical results are applicable to minor epidemics in stochastic SIR, SIS, and SIRS models with a single infected class. The probability density for minor epidemics in more complex epidemic models can be computed numerically applying multitype branching processes and the backward Kolmogorov differential equations. When ℛ 0 is close to one, minor epidemics are more common than major epidemics and their duration is significantly longer than when ℛ 0 ≪ 1 or ℛ 0 ≫ 1 .