Pulmonary in SJS/TEN

Q: What could be the pulmonary findings in Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN)?

Answer: sloughing of the bronchial epithelium

SJS/TEN can involve any organ, including the eye, kidney, GI tract, or liver. About one in four patients gets pulmonary involvement. On bronchoscopy, sloughing of the bronchial epithelium can indicate direct pulmonary involvement. Additionally, common complications may include pneumonia, pulmonary edema, atelectasis, and ARDS. These patients have a high chance of respiratory failure requiring a ventilator.

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#Allergy-immunology

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References:

1. Wankhade BS, Alrais ZF, Beniamein MMK, Issa LH, Eldelpshany MSA. Acute pulmonary complication of Stevens-Johnson syndrome-toxic epidermal necrolysis overlap. Anaesthesiol Intensive Ther. 2025 Apr 15;57(1):70-72. doi: 10.5114/ait/200234. PMID: 40237533; PMCID: PMC12210361.

2. Lee KCH, Ko JP, Oh CC, Sewa DW. Managing respiratory complications in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. Int J Dermatol. 2022 Jun;61(6):660-666. doi: 10.1111/ijd.15888. Epub 2021 Sep 8. PMID: 34494255.

3. Woo T, Saito H, Yamakawa Y, Komatsu S, Onuma S, Okudela K, Nozawa A, Aihara M, Ikezawa Z, Ishigatsubo Y. Severe obliterative bronchitis associated with Stevens-Johnson syndrome. Intern Med. 2011;50(22):2823-7. doi: 10.2169/internalmedicine.50.5582. Epub 2011 Nov 15. PMID: 22082897.