Yonsei Med J.  2015 Mar;56(2):578-581. 10.3349/ymj.2015.56.2.578.

Bronchiolitis Obliterans Associated with Stevens-Johnson Syndrome: A Case Report

• Park H
• Ko YB
• Kwon HS
• Lim CM

• KMID: 2070041
• DOI: http://doi.org/10.3349/ymj.2015.56.2.578

Abstract

We report a case of bronchiolitis obliterans associated with Stevens-Johnson syndrome. A 59-year-old man presented with respiratory distress that gradually worsened over 3 months. He had been diagnosed with Stevens-Johnson syndrome 3 months before admission. He had no history of previous airway disease. On physical examination, expiratory breathing sounds were not audible, and a chest X-ray revealed a hyperinflated lung. A pulmonary function test indicated a severe obstructive pattern. Computed tomography scans of inspiratory and expiratory phases of respiration showed oligemia and air trapping, and both were more prominent on expiration view than on inspiration view. The pathogenesis of bronchiolitis obliterans associated with Stevens-Johnson syndrome is largely unknown.

Keyword

Stevens-Johnson syndrome; bronchiolitis obliterans; dyspnea

MeSH Terms

Anti-Bacterial Agents/therapeutic use
Bronchiolitis Obliterans/etiology/*radiography/therapy
Bronchoscopy
Dyspnea/*complications
Fatal Outcome
Humans
Male
Middle Aged
Radiography, Thoracic
Respiratory Distress Syndrome, Adult/*etiology/therapy
Respiratory Function Tests
Roxithromycin/therapeutic use
Stevens-Johnson Syndrome/*complications/drug therapy
Tomography, X-Ray Computed/methods
Tracheostomy
Anti-Bacterial Agents
Roxithromycin

Figure

• 

  Fig. 1 (A) Chest radiograph 6 weeks prior to admission showing normal findings. Note that the dome of the right diaphragm is at the level of the 10th rib posterior arc. (B) Chest radiograph showing hyperinflated lung without significant opacities. Note that the dome of the right diaphragm is at the level of the 11th rib posterior arc.

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  Fig. 2 Inspiratory and expiratory CT scans of 59-year-old male patient with bronchiolitis obliterans associated with SJS. (A) Inspiratory CT scan revealing a partially low attenuated lung lesion, collapsed vascular structure (oligemia and air trapping), and mild bronchial dilatation. (B) Expiratory CT scan revealing more prominent findings, such as shifted interlobular fissure, lower attenuated lung lesion, collapsed vascular structure, and obstructed bronchus. (C and D) Another set of inspiratory and expiratory CT images of the patient. SJS, Stevens-Johnson syndrome.

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