Intensive Care Medicine

, 23:1237

Pulmonary complications in toxic epidermal necrolysis: a prospective clinical study

  • F. Lebargy
  • P. Wolkenstein
  • M. Gisselbrecht
  • F. Lange
  • J. Fleury-Feith
  • C. Delclaux
  • E. Roupie
  • J. Revuz
  • J. C. Roujeau
Originals

DOI: 10.1007/s001340050492

Cite this article as:
Lebargy, F., Wolkenstein, P., Gisselbrecht, M. et al. Intensive Care Med (1997) 23: 1237. doi:10.1007/s001340050492

Abstract

Objective: To evaluate the incidence, clinical features, and prognosis of pulmonary complications associated with toxic epidermal necrolysis

Design: Prospective study.

Setting: Dermatology intensive care unit in Mondor Hospital, France.

Patients: 41 consecutive patients.

Interventions: On admission, then daily, respiratory evaluation was based on clinical examination, chest X-ray, and arterial blood gas analysis. When clinical symptoms, X-ray abnormalities, or hypoxemia [partial pressure of oxygen (PO2)<80 mm Hg] were present, fiberoptic bronchoscopy was performed.

Results: 10 patients presented early manifestations: dyspnea (n=10), bronchial hypersecretion (n=7), marked hypoxemia (n=10) (PO2=59 ± 8 mmHg). Chest X-ray was normal (n = 8) or showed interstitial infiltrates (n=2). In these 10 patients, fiberoptic bronchoscopy demonstrated sloughing of bronchial epithelium in proximal airways. Delayed pulmonary complications occurred in 6 of these 10 patients from day 7 to day 15: pulmonary edema (n=2), atelectasis (n=1), bacterial pneumonitis (n=4). Mechanical ventilation was required in 9 patients. A fatal outcome occurred in 7 patients. Seven patients did not develop early pulmonary manifestations (PO2 on admission 87 ± 6 mm Hg) but only delayed pulmonary symptoms related to atelectasis (n=1), pulmonary edema (n=4), and bacterial pneumonitis (n=3); bronchial epithelial detachment was not observed. None of them required mechanical ventilation and all recovered with appropriate therapy.

Conclusions: “Specific” involvement of bronchial epithelium was noted in 27 % of cases and must be suspected when dyspnea, bronchial hypersecretion, normal chest X-ray, and marked hypoxemia are present during the early stages of toxic epidermal necrosis. Bronchial injury seems to indicate a poor prognosis, as mechanical ventilation was required for most of these patients and was associated with a high mortality.

Key words

Toxic epidermal necrolysisStevens-Johnson syndromePulmonary complicationsFiberoptic bronchoscopyBronchial epithelial necrosis

Copyright information

© Springer-Verlag 1997

Authors and Affiliations

  • F. Lebargy
    • 1
  • P. Wolkenstein
    • 1
  • M. Gisselbrecht
    • 1
  • F. Lange
    • 1
  • J. Fleury-Feith
    • 1
  • C. Delclaux
    • 1
  • E. Roupie
    • 1
  • J. Revuz
    • 1
  • J. C. Roujeau
    • 1
  1. 1.Höpital Henri-MondorCreteilFrance
  2. 2.Service de DermatologieHöpital H.MondorCréteilFrance
  3. 3.Service de PneumologieHöpital de Maison BlancheReimsFrance