Severe Obliterative Bronchitis Associated with Stevens-Johnson Syndrome
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概要
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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 PaCO2 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.
著者
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Ishigatsubo Yoshiaki
Department Of Internal Medicine And Clinical Immunology Yokohama City University Graduate School Of
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Onuma Sumi
Department Of Dermatology Yokohama City University School Of Medicine Urafune Hospital
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KOMATSU Shigeru
Department of Anatomy Shinshu University School of Medicine
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Ikezawa Zenro
Department Of Dermatology Yokohama City University Hospital
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Okudela Koji
Department Of Pathology Hamamatsu University School Of Medicine
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Aihara Michiko
Department Of Dermatology Juntendo University School Of Medicine
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WOO Tetsukan
Department of Surgery, Yokohama City University Graduate School of Medicine
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NOZAWA Akinori
Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine
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Saito Haruhiro
Department of Respiratory Medicine, Yokohama City University School of Medicine, Japan
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Okudela Koji
Department of Pathology, Yokohama City University School of Medicine, Japan
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Yamakawa Yasushi
Department of Respiratory Medicine, Yokohama City University School of Medicine, Japan
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Woo Tetsukan
Department of Respiratory Medicine, Yokohama City University School of Medicine, Japan
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Aihara Michiko
Department of Dermatology, Yokohama City University School of Medicine, Japan
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