Question

Pulmonary fibrosis with skin pigmentation is a characteristic adverse effect of

• A. Doxorubicin
• B. Cyclophosphamide
• C. Bleomycin
• D. Cisplatin

Hint:

Anticancer drugs often have characteristic dose-limiting toxicities. Recognising the signature side effect of each drug is a common exam point.

Answer 1

The Correct Option is C

Step 1: What is the question asking?
We need to identify which anticancer drug causes both pulmonary fibrosis and skin pigmentation as characteristic adverse effects. These two together are a classic exam clue.

Step 2: Evaluate Option 3 - Bleomycin.
Bleomycin is a cytotoxic antibiotic used in cancers like Hodgkin's lymphoma and testicular cancer. Its most serious and well-known adverse effect is pulmonary fibrosis, which can be life-threatening. It also causes skin changes including hyperpigmentation, especially over pressure points, and can cause blistering. Pulmonary fibrosis + skin pigmentation = Bleomycin. This is the correct answer.

Step 3: Why does Bleomycin cause lung toxicity?
The lung lacks significant bleomycin hydrolase (the enzyme that inactivates bleomycin). So the drug accumulates in lung tissue and generates free radicals that cause oxidative damage, leading to inflammation and fibrosis.

Step 4: Evaluate Option 1 - Doxorubicin.
Doxorubicin's classic adverse effect is cardiotoxicity (dilated cardiomyopathy), not pulmonary fibrosis. It can also cause red coloration of urine.

Step 5: Evaluate Option 2 - Cyclophosphamide.
Cyclophosphamide characteristically causes hemorrhagic cystitis (bladder toxicity from acrolein metabolite). It can occasionally affect the lungs but this is not its hallmark.

Step 6: Evaluate Option 4 - Cisplatin and Conclusion.
Cisplatin is notorious for nephrotoxicity, ototoxicity, and peripheral neuropathy. Not known for pulmonary fibrosis or skin pigmentation. Only Bleomycin fits the hallmark pair described.
Answer: Option (3) — Bleomycin