When should you worry about bronchiolitis obliterans?

Abstract

In this volume of The Journal, Carpenter et al describe a case series of 68 patients with Stevens Johnson Syndrome (SJS), reporting that 9% develop bronchiolitis obliterans. This is potentially an important observation, as it serves to underscore the need to have sufficient diagnostic suspicion to screen for bronchiolitis obliterans in at-risk patients. At the same time, questions remain. The first question centers on case definition of SJS. The authors include both Mycoplasma-induced SJS and drug-induced SJS. With the retrospective design covering January 2004-December 2016, it is not possible to determine whether many of these cases were actually Mycoplasma-induced rash and mucositis (MIRM), a newly described entity (J Am Acad Dermatol 2015;72:239-45). This is particularly important given the relatively high percentage of Mycoplasma-induced SJS and recurrent SJS in those with bronchiolitis obliterans. No patients with bronchiolitis obliterans had drug-induced SJS. We should also note that these cases are from Children's Hospital Colorado. As the mechanism is not yet clear, one speculation is that bronchiolitis obliterans may be more manifest related to altitude or relative hypoxemia. Despite these caveats the report serves to highlight one important complication of these entities and to propose some guidance around screening. As with any rare complication of an already-rare condition, the aggregate experience of multiple centers will need to be examined to clarify the clinical picture. Article page 307 ▸ Stevens-Johnson Syndrome in Children: Consider Monitoring for Bronchiolitis ObliteransThe Journal of PediatricsVol. 236PreviewWe reviewed patients with Stevens-Johnson syndrome (SJS) evaluated at Children's Hospital Colorado and investigated the occurrence of bronchiolitis obliterans (BO). Approximately 9% of patients with SJS developed BO. Pediatricians should consider monitoring patients with SJS for BO, especially those with recurrent SJS and patients treated with mechanical ventilation. Full-Text PDF