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Case Reports
. 2016 Jan 20:17:54-6.
doi: 10.1016/j.rmcr.2016.01.006. eCollection 2016.

Phenytoin induced Steven-Johnson syndrome and bronchiolitis obliterans - case report and review of literature

Bibek S Pannu  1 , Ashley M Egan  2 , Vivek N Iyer  1
Affiliations
Case Reports

Phenytoin induced Steven-Johnson syndrome and bronchiolitis obliterans - case report and review of literature

Bibek S Pannu et al. Respir Med Case Rep. .

Abstract

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are both rare but serious idiosyncratic drug reactions characterized by diffuse muco-epidermoid injury and high mortality. Keratinocytes in both skin and mucous membranes (including eyes, mouth and genitalia) are injured resulting in a diffuse maculopapular rash, blistering lesions and epithelial detachment with minimal force (Nikolsky's sign). SJS is typically diagnosed when less than 10% of the skin surface is involved and the term TEN is used in cases with more than 30% involvement. Respiratory involvement in SJS-TEN is common with 30-50% of cases demonstrating respiratory epithelial sloughing with severe short and long term complications. Patients who survive SJS-TEN are often left with impaired respiratory function and bronchiolitis obliterans. Cases of bronchiolitis obliterans with SJS/TEN have been very rarely reported. We report a case of phenytoin induced SJS/TEN followed by severe bronchiolitis obliterans in an adult patient. The presentation, pathophysiology and management of SJS/TEN related bronchiolitis obliterans is also reviewed.

Keywords: Bronchiolitis obliterans; Phenytoin; Stevens Johnson syndrome; Toxic epidermal necrolysis.

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Figures

Fig. 1
Fig. 1
Chest X-ray.
Fig. 2
Fig. 2
Chest CT scan.
See this image and copyright information in PMC

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