Progressive bronchial obstruction associated with toxic epidermal necrolysis

Abstract

Toxic epidermal necrolysis (TEN) is an acute life-threatening condition, characterized by erosion of the mucous membranes, extensive detachment of the epidermis, and severe constitutional symptoms. Pulmonary complications of TEN are reported as rare, but are one of the most common causes of death. Our report focuses on an unusual case of toxic epidermal necrolysis which showed multiple bronchial obliteration during the chronic phase of the disease. Biopsied tissue of the obliterated bronchi demonstrated non-specific granulation. To improve the obliterated ventilatory function, we tried to reopen the bronchial obliteration using a balloon catheter under the guidance of fibreoptic bronchoscopy, however rapid restenosis of the bronchi ensued.

Severe Obliterative Bronchitis Associated with Stevens-Johnson Syndrome

“…Fourteen cases of obliterative bronchitis or bronchiolitis following SJS/TEN have been reported (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23). Two cases were thought to result from SJS brought on by mycoplasma infections (11,12), and 11 cases were thought to have been related to SJS / TEN caused by drugs (13)(14)(15)(16)(17)(18)(19)(21)(22)(23). Six cases of severe respiratory failure, similar to that of the present patient, resulted in fatalities from 2 months to one and a half years after the onset of SJS/TEN (11,12,15,20,21,23).…”

“…Two cases were thought to result from SJS brought on by mycoplasma infections (11,12), and 11 cases were thought to have been related to SJS / TEN caused by drugs (13)(14)(15)(16)(17)(18)(19)(21)(22)(23). Six cases of severe respiratory failure, similar to that of the present patient, resulted in fatalities from 2 months to one and a half years after the onset of SJS/TEN (11,12,15,20,21,23). One patient developed progressive respiratory failure due to obliterative bronchiolitis, and underwent a living-donor lung transplantation 6 months after the onset of SJS (22).…”

“…The other patients were discharged, but they all had prolonged respiratory complaints (13,14,(16)(17)(18)(19). There are no reports of patients who have survived on mechanical ventilation due to obliterative bronchitis or bronchiolitis after SJS / TEN (11,12,15,20,21,23).…”

“…However, there are only a few reports concerning chronic pulmonary complications in patients with SJS/TEN (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23). We herein report a patient with SJS who had been diagnosed with severe obliterative bronchitis and died due to respiratory failure.…”

Complications of Stevens–Johnson syndrome beyond the eye and skin

“…Histologic examinations of pulmonary tissues at sites of obstruction have shown loss of the bronchial epithelium, replacement by fibrous granulation tissue, and complete obliteration of segmental bronchi [31][32][33]. The pathogenesis of chronic pulmonary sequelae in SJS/TEN is not well understood.…”