A case of Stevens-Johnson Syndrome associated with bronchiolitis obliterans

Abstract

Introduction: Bronchiolitis obliterans (BO) is as a rare pulmonary complication of Stevens Johnson Syndrome (SJS). We present a patient who was thought to have BO after SJS but there was no radiological finding compatible with BO on the first thorax CT. However one month later thorax CT findings became consistent with BO. Case Report: A 12-year-old female patient was diagnosed with SJS after using oseltamivir, ibuprofen and trimethoprim sulfometaxazole and was treated with IVIG and steroids. One month later, she had cough, shortness of breath. Physical examination revealed bilateral decreased breath sounds, common rhonchi and crackles on both lungs. Oxygen saturation was 95% and respiratory rate was 20/min. Obstructive and restrictive patterns were detected in pulmonary function test (PFT). There was no findings compatible with BO on thorax CT in the expiratory phase. Steroid, azithromycin and chest physiotherapy were started due to the clinical findings and PFT results suggesting BO. In the second month control, bilateral patchy air trapping and peribronchial thickening were detected in thorax CT in the expiratory phase, which are thought to be compatible with BO. Steroid therapy was tapered and stopped due to significant improvement in the patient9s clinical findings. Method: Bronchiolitis obliterans secondary to SJS is generally progressive and has poor prognosis. Close monitoring of patients with SJS is important for timely detection of BO. BO is mainly diagnosed by thorax CT however radiological findings may occur in the late period.