title: Severe obliterative bronchitis associated with Stevens-Johnson syndrome.
abstract: We report a case of Stevens-Johnson syndrome (SJS) in which the patient had been diagnosed with severe obliterative bronchitis. A 29-year-old woman was admitted with a high fever and a widespread vesicular rash. She was diagnosed with SJS and betamethasone administration was started. After one month, her vesicular skin rash improved; however, she developed respiratory failure and was assisted with mechanical ventilation. Computed tomography of the chest demonstrated a hyperlucent lung with narrowing of the peripheral vessels. Bronchoscopy revealed an occlusion of the bronchus when the patient exhaled. The flow-volume curve revealed a severe obstructive pattern. The patient was diagnosed with obliterative bronchitis following SJS. She was treated with a bronchodilator and steroids, but could not breathe adequately without the ventilator. During the following year, her PaCO(2) increased to 100 torr and her heart function also continued to worsen. Despite intensive treatment, she died one year and seven months after the onset of SJS. In SJS and toxic epidermal necrolysis (TEN) patients, chronic pulmonary complications are rare, but there is no effective therapy for obliterative bronchitis following SJS/TEN. Therefore, early awareness of this condition is needed and lung transplantation must be considered at an early stage of this disease.
authors.affiliation: Department of Respiratory Medicine, Yokohama City University School of Medicine, Japan. tetsu.n.u@cotton.ocn.ne.jp
authors.forename: Tetsukan
authors.initials: T
authors.lastname: Woo
authors.forename: Haruhiro
authors.initials: H
authors.lastname: Saito
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Yamakawa
authors.forename: Shigeru
authors.initials: S
authors.lastname: Komatsu
authors.forename: Sumi
authors.initials: S
authors.lastname: Onuma
authors.forename: Koji
authors.initials: K
authors.lastname: Okudela
authors.forename: Akinori
authors.initials: A
authors.lastname: Nozawa
authors.forename: Michiko
authors.initials: M
authors.lastname: Aihara
authors.forename: Zenro
authors.initials: Z
authors.lastname: Ikezawa
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Ishigatsubo
mesh_terms: D000328:Adult; D001623:Betamethasone / Q000627:therapeutic use; D001991:Bronchitis / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000209:etiology; D013262:Stevens-Johnson Syndrome / Q000150:complications* / Q000188:drug therapy
chemical_list: D001623:Betamethasone