Bronchiolitis obliterans due to toxic epidermal necrolysis with structural evaluation using computed tomography
Hidemasa Kudo1, Ken Katsuta1, Shigeki Kushimoto1
1Department of Emergency and Critical Care Medicine Tohoku University Hospital Sendai Japan.
Background:
Toxic epidermal necrolysis (TEN) can lead to various extracutaneous complications, including respiratory involvement. We present a case of a patient who developed bronchiolitis obliterans (BO) after the acute phase of TEN, with computed tomography (CT) bronchography revealing bronchial tree structural changes.
Case Presentation:
A 60-year-old woman presented with a rash and hoarseness 2 days after taking ibuprofen and was diagnosed with TEN. While her cutaneous symptoms improved by day 20, the flow-volume loop indicated obstructive respiratory failure. CT bronchography revealed bead-like changes and mural irregularities in the bronchi; thus, BO was diagnosed. Despite treatment with bronchodilators and steroids, she required long-term mechanical ventilation with persistent bronchial alterations.
Conclusion:
Extracutaneous complications of TEN are crucial, particularly in BO development following the acute phase. In this case, CT bronchography showed treatment-refractory bead-like changes and mural irregularities in the bronchioles.
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