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Severe airflow obstruction and eosinophilic lung disease after Stevens–Johnson syndrome

¹ Depts of Medicine, Pulmonary and Critical Care Unit, and ² Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA.

CORRESPONDENCE: A. P. Shah, 601 Elmwood Avenue, Box 692, Rochester, NY 14586, USA. Fax: 1 5852731114. E-mail: alpashah{at}hotmail.com

Keywords: Constrictive bronchiolitis, eosinophilic micro-abscesses, pulmonary disease, Stevens–Johnson syndrome

Received: March 13, 2006
Accepted July 10, 2006

Respiratory involvement is a frequent complication of Stevens–Johnson syndrome (SJS). However, there are very few convincing reports of persistent pulmonary sequelae, as demonstrated by spirometry, radiology and pathology.

The current study presents a case of a 13-yr-old female with T-cell acute lymphocytic leukaemia who developed persistent, severe, obstructive lung disease following an episode of SJS.

A lung biopsy demonstrated bronchiolar submucosal fibrosis consistent with constrictive bronchiolitis, as well as eosinophilic micro-abscesses, which, to the current authors’ knowledge, has not been previously described.

The present study illustrates specific histopathological features that highlight a possible association between Stevens–Johnson syndrome, constrictive bronchiolitis and eosinophilic micro-abscesses. The eosinophils may be associated with permanent mucosal damage, as seen in the present case, by releasing mediators that have a pro-fibrogenetic role. However, further investigation is warranted.