Source: International Congress 2014 – Clinical management of interstitial lung diseases and vasculitis
Disease area: Paediatric lung diseases

Abstract

Back groundObliterative Bronchiolitis (OB) after Stevens-Johnson syndrome (SJS) associated with mycoplasma infection is rare .We present 3 cases including their presentation, diagnosis and HRCT findings.Case ReportsThree children aged 7(girl), 11 and 13(two boys) presented with persistent wet cough and reduced exercise tolerance not responding to antibiotics or bronchodilators. They had a history of SJS with positive IgM for Mycoplasma pneumoniae 6 to 8 months prior to presentation. All had consolidation on chest radiograph at the time of acute illness.Examination revealed polyphonic wheeze and crepitation in first two cases. Spirometry at presentation showed an obstructive pattern (FEV₁ 53%, 62% and 114.8% of predicted respectively). There was no bronchodilator reversibility or response to steroids in all three.HRCT showed regional air trapping in all three cases confirming OB .The 11 year old boy also had peribronchial thickening and bronchiectasis. He had a recurrence of SJS three years later, but no respiratory deterioration.Lung function (FEV₁ 72%, 75% and 122% of predicted) and exercise tolerance improved slightly with chest physiotherapy and antibiotics for acute exacerbations. Whilst reported symptoms improved considerably, repeat HRCT in the first two cases showed persistence of initial changes with only marginal improvement.DiscussionOB post mycoplasma associated SJS in these slightly older, previously healthy children resulted in significant morbidity. OB should be suspected in children with chronic respiratory symptoms following an episode of SJS associated with mycoplasma pneumoniae. The diagnosis can be confirmed by HRCT. Symptoms improve significantly with appropriate treatment.

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Citations should be made in the following way:
L. Nair, S. Moss (Newcastle, United Kingdom). Obliterative bronchiolitis post mycoplasma associated Stevens-Johnson syndrome. Eur Respir J 2014; 44: Suppl. 58, 4507

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