Chronic pulmonary complications due to toxic epidermal necrolysis

Sun Hye Hwang; Dong Hyun Kim; Jeong Hee Kim; Byong Kwan Son; Dae Hyun Lim

doi:10.4168/aard.2013.1.4.391

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Hwang, Kim, Kim, Son, and Lim: Chronic pulmonary complications due to toxic epidermal necrolysis

Case Report

Allergy, Asthma & Respiratory Disease 2013; 1(4): 391-394.

Published online: 31 December 2013

DOI: https://doi.org/10.4168/aard.2013.1.4.391

Chronic pulmonary complications due to toxic epidermal necrolysis

Sun Hye Hwang, Dong Hyun Kim, Jeong Hee Kim, Byong Kwan Son, Dae Hyun Lim

Department of Pediatrics, Inha University School of Medicine, Incheon, Korea.

Correspondence to: Jeong Hee Kim. Department of Pediatrics, Inha University Hospital, Inha University School of Medicine, 27 Inhang-ro, Jung-gu, Incheon 400-711, Korea. Tel: +82-32-890-2843, Fax: +82-32-890-2844, kimjhmd@inha.ac.kr

Received 8 July 2013 Revised 23 September 2013 Accepted 1 October 2013

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/).

Abstract

Toxic epidermal necrolysis (TEN) is the most severe form of skin reactions caused by drugs or infection. Acute pulmonary complications in TEN are often observed. The mortality is especially high in those who suffer chronic pulmonary complications of TEN such as bronchiolitis obliterance, which occur as a consequence of bronchial epithelial injury. We report a case of a 16-year-old male who had required mechanical ventilation due to acute respiratory distress syndrome caused by TEN at 8 years of age. Although the patient initially recovered from acute respiratory distress syndrome, he required mechanical ventilation again due to severe chronic pulmonary complications of bronchiolitis obliterance and bronchiectasis caused by respiratory epithelial detachment. Thereafter, chronic bronchitis and chronic sinusitis has persisted due to mucosal ciliary dysfunction and several episodes of spontaneous pneumothorax has occurred. However, despite these persisting and serious sequelae of TEN, the patient has survived for 8 years. We report a rare case of a patient with long-term chronic pulmonary complications who had previously suffered TEN 8 years ago.

Keywords: Toxic epidermal necrolysis, Recurrent spontaneous pneumothorax, Pulmonary complication

Figures and Tables

Fig. 1

Plain chest X-ray showed right pneumothorax and left residual pneumothorax.

Fig. 2

(A) Pulmonary findings of a high resolution computed tomography scan showed marked right pneumothorax. (B) Bronchiectasis and bronchiolitis obliterance were observed in the both lung field.

Fig. 3

(A) Biopsied tissues from the right upper lobe showed emphysematous change and 5-cm diameter bullae (H&E, ×12.5). (B) Septum interstitial tissue showed edematous change and multifocal lymphocyte and plasma cell infiltration (H&E, ×100).

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