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J Thorac Cardiovasc Surg 2002;123:389-391
© 2002 The American Association for Thoracic Surgery

Brief Communications

Living-donor lobar lung transplantation for bronchiolitis obliterans after Stevens-Johnson syndrome

From the Departments of Surgery II,^a Anesthesiology and Resuscitology,^b and Cardiovascular Surgery,^c Okayama University School of Medicine, Okayama, Japan.

Received for publication July 11, 2001. Accepted for publication July 26, 2001. Address for reprints: Hiroshi Date, MD, Department of Surgery II, Okayama University School of Medicine, 2-5-1 Shikata-Cho, Okayama 700-8558, Japan (E-mail: hdate@nigeka2.hospital.okayama-u.ac.jp).

Stevens-Johnson syndrome (SJS) is an acute self-limited eruption of the skin and mucous membranes that represents a hypersensitivity reaction to various etiologic agents. ¹ Underlying causes include exposure to drugs, various microbial diseases, malignant tumors, and connective tissue diseases. Specific involvement of bronchial epithelium is relatively uncommon but indicates a poor prognosis. ² As a consequence of airway epithelial injury, bronchiolitis obliterans can occur. ³

To our knowledge, this is the first reported case of living-donor lobar lung transplantation for bronchiolitis obliterans associated with SJS.

Clinical summary
A 13-year-old boy who was well until September 16, 2000, received oral medication (cefcapene pivoxil hydrochloride, amantadine hydrochloride) for an upper respiratory tract infection. Twenty-four hours later, he had redness in both eyes followed by a generalized erythematous maculopapular skin rash with high-grade intermittent fever. The rash progressed to become vesiculobullous, affecting more than 80% of the body surface area. SJS was diagnosed clinically and the boy was treated with corticosteroid drugs. However, hematuria developed and mechanical ventilation was instituted on September 23 because of massive hemoptysis. The chest computed tomographic scan demonstrated parenchymal infiltrates caused by pulmonary hemorrhage(Figure 1, A). Bronchoscopic examination revealed ulcerative and exudative lesions with sloughing of mucosa . . . [Full Text of this Article]

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